title: Minimally invasive inguinal lymph node dissection (MILND) for melanoma: experience from two academic centers.
abstract: OBJECTIVE
  Regional lymph nodes are the most frequent site of spread of metastatic melanoma. Operative intervention remains the only potential for cure, but the reported morbidity rate associated with inguinal lymphadenectomy is approximately 50%. Minimally invasive lymph node dissection (MILND) is an alternative approach to traditional, open inguinal lymph node dissection (OILND). The aim of this study is to evaluate our early experience with MILND and compare this with our OILND experience.
  
  
  METHODS
  We conducted a prospective study of 13 MILND cases performed for melanoma from 2010 to 2012 at two tertiary academic centers. We compared our outcomes with retrospective data collected on 28 OILND cases performed at the same institutions, by the same surgeons, between 2002 and 2011. Patient characteristics, operative outcomes, and 30-day morbidity were evaluated.
  
  
  RESULTS
  Patient characteristics were similar in the two cohorts with no statistically significant differences in patient age, gender, body mass index, or smoking status. MILND required longer operative time (245 vs 138 min, p=0.0003). The wound dehiscence rate (0 vs 14%, p=0.07), hospital readmission rate (7 vs 21%, p=0.25), and hospital length of stay (1 vs 2 days, p=0.01) were all lower in the MILND group. The lymph node count was significantly higher (11 vs 8, p=0.03) for MILND compared with OILND.
  
  
  CONCLUSIONS
  MILND for melanoma is a novel alternative to OILND, and our preliminary data suggest that MILND provides an equivalent lymphadenectomy while minimizing the severity of postoperative complications. Further research will need to be conducted to determine if the oncologic outcomes are similar.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Abbott
authors.forename: Travis E
authors.initials: TE
authors.lastname: Grotz
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Hernandez Irizarry
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
authors.forename: James W
authors.initials: JW
authors.lastname: Jakub
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000473:pathology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010359:Patient Readmission; D012878:Skin Neoplasms / Q000473:pathology*; D018709:Statistics, Nonparametric; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology*