title: Oncologic outcomes of patients undergoing videoscopic inguinal lymphadenectomy for metastatic melanoma.
abstract: BACKGROUND
  Open inguinal lymphadenectomy for regionally metastatic melanoma is associated with a high wound-related morbidity. Videoscopic inguinal lymphadenectomy (VIL) is a minimally invasive approach with fewer wound-related complications, yet its adoption has been hindered by a lack of oncologic outcomes data.
  
  
  METHODS
  Data were prospectively collected on all VILs performed for melanoma from 2008 to 2012 (n = 40) and compared with a retrospective cohort of open superficial inguinal lymphadenectomies from 2005 to 2012 (n = 40). Continuous variables were analyzed with Student's t-test, binomial variables with chi-square, and survival curves using log-rank comparison.
  
  
  RESULTS
  Median follow-up for patients undergoing VIL was 19.1 months compared with 33.9 months in the open inguinal lymphadenectomy group. There were no statistical differences in demographics (age, sex, body mass index, smoking status, Charlson comorbidity index) or clinicopathologic features (primary site, stage, Breslow depth, ulceration). Lymph node yield was similar (VIL, 12.6; open, 14.2; p = 0.131). Overall recurrence rates were also similar: 27.5% in the VIL group and 30.0% in the open group (p = 0.805). One patient in the VIL group and 2 in the open group suffered recurrence in the nodal basin. Although median survival was not reached in the VIL group, Kaplan-Meier estimates of disease-free survival (p = 0.226) and overall survival (p = 0.308) were similar. In a comprehensive analysis of wound complications including infection, skin necrosis, and seroma, patients undergoing VIL had markedly less morbidity (VIL, 47.5%; open, 80.0%; p = 0.002).
  
  
  CONCLUSIONS
  Videoscopic inguinal lymphadenectomy is associated with similar oncologic outcomes and markedly reduced wound complications when compared with open inguinal lymphadenectomy. The minimally invasive procedure may be the preferred method for inguinal lymphadenectomy in melanoma.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Martin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Joanna W
authors.initials: JW
authors.lastname: Etra
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Russell
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: Department of Urology, Winship Cancer Institute-Emory University, Atlanta, GA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute-Emory University, Atlanta, GA. Electronic address: kdelman@emory.edu.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D020535:Video-Assisted Surgery; D055815:Young Adult