title: Inguinal lymphadenectomy for stage III melanoma: a comparative study of two surgical approaches at the onset of lymphoedema.
abstract: BACKGROUND
  When sentinel lymph node is positive for metastasis (exclusion for micro-metastasis) and in cases of palpable adenopathy, a lymphadenectomy should be performed. Many incisional surgical approach have been described in literature. We perform two type of incision (vertical with skin excision and transversal) for inguinal lymphadenectomy. The aim of this study was to compare post-operative morbidity between these two approach in cases of Stage III Melanoma. We analysed chronic lymphoedeme, skin necrosis, wound dehiscence, wound infection and seroma rates between the two techniques.
  
  
  METHODS
  From April 2000 to February 2012 fifty-three patients underwent to inguinal lymphadenectomy for Stage III melanoma at CHU of Rennes. Patients were stratified in 2 groups according to the surgical approach, group 1 with a vertical incision with skin excision and group 2 with a transverse incision.
  
  
  RESULTS
  Chronic lymphoedema rate for group 1 was 37.04% and for group 2 rate was 26.92%, this complication was lower un group 2 but no significant difference was observed (p = 0.558). Skin necrosis (p = 0.235), wound dehiscence (p = 1.000), wound infection (p = 0.236) and seroma (p = 0.757) were not significantly different. Two cases of skin necrosis were observed in group 2 (7.69%) and none in group 1.
  
  
  CONCLUSIONS
  We do not found significant difference for chronic lymphoedema between these two approach. However, we had less lymphoedema with the transversal technique which has the advantage to reduce the skin suffering when external iliac lymphadenectomy dissection is necessary in addition to the inguinal lymphadenectomy.
authors.affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200 Rennes, France; SITI Laboratory, Etablissement Français du Sang Bretagne, Rennes University Hospital, Rennes, France; STROMAlab, UMR5273 CNRS/UPS/EFS - INSERM U1031, Rangueil Hospital, Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Bertheuil
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France.
authors.forename: L
authors.initials: L
authors.lastname: Sulpice
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France. Electronic address: gblevisandri@gmail.com.
authors.forename: G B
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: Department of Gynecology, CHU Anne de Bretagne, Rennes, France.
authors.forename: V
authors.initials: V
authors.lastname: Lavoué
authors.affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35200 Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Watier
authors.affiliation: Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France.
authors.forename: B
authors.initials: B
authors.lastname: Meunier
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology*; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology; D009367:Neoplasm Staging; D049291:Seroma / Q000209:etiology; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology
keywords: Inguinal lymphadenectomy; Lymphoedema; Stage III melanoma; Surgery