PURPOSE: Sentinel lymph node biopsy (SLNB) is an essential surgical procedure in staging and management of intermediate-thick melanomas. Although recent studies have shown that complete lymph node dissection (CLND) does not improve 3-years specific survival, its usefulness in increasing disease-free period and control of local disease remains confirmed. The most frequent complication related to CLND is lymphedema, that could affect, in either its clinical or subclinical form, up to 40% of patients undergoing CLND. Our purpose was to assess the preventive use of lymphatic-venous micro-anastomoses in avoiding such complication.
MATERIALS AND METHODS: We performed a single-institution retrospective case-control study, including patients treated with CLND from June 1994 to December 2016. CLND was proposed to all subjects with positive-SLNB; from 2012, a preventive procedure with preparation of multiple lymphaticovenular anastomoses, which we named preventive multiple anastomoses (PMA) was proposed to subjects undergoing CLND. Frequency of lymphedema was compared among subjects that were or were not treated with PMA during CLND.
RESULTS: Database evaluation revealed 26 patients treated with PMA during CLND (PMA group) and 138 subjects who underwent CLND without PMA (control group). In patients with almost 3-years of follow-up, frequency of lymphedema was significantly lower in PMA group than in control group (4.3% vs 24.1%, p<0.05). Patients of PMA group and control group showed similar 3-years recurrence-free period (65.2% vs 62.5%, log-rank test p=0.80) and 3-year overall survival (73.9% vs 72.5%, log-rank test p=0.89) and frequency of nonsentinel-node metastases (26.7% vs 30.4%, p=0.71).
CONCLUSION: We have demonstrated that PMA represents a useful and safe procedure in prevention of lymphedema in melanoma patients undergoing CLND. PMA could sensibly reduce complication related to CLND, while allowing the control of regional disease and an increase in diseases free-period.