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ILNDInguinal Lymph Node Dissection (cancer operation)
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(13) Thus lesions with high-risk features should be managed with modified inguinal lymph node dissection (ILND) even if patients are clinically node negative.
These patients do not require inguinal lymph node dissection. If lesions are greater than 2 cm and/or have greater than 1 mm depth of invasion, a lymph node dissection is indicated.
The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity.
Twenty-one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity between February 2011 and April 2013 were included in this study.
Inguinal lymph node dissection was performed through a standard 12 cm incision extending from 2 cm below the inguinal ligament to the apex of the femoral triangle.
He developed a right inguinal lymph node recurrence and underwent an inguinal lymph node dissection 2 years later.
He underwent an inguinal lymph node dissection of which 1/5 lymph nodes were positive for melanoma.
Following a biopsy (incisional) confirmation of angiosarcoma, a 97.5 x 41.0 x 13.0-cm portion of abdominal wall weighing 75 lb with bilateral superficial inguinal lymph node dissection was received.
Early inguinal lymph node dissection in men with clinically negative nodes, but at high risk for nodal involvement, significantly improves cancer-specific survival and can be curative in 20% to 60% of histologically node-positive patients.[sup.34] However, even in node-negative men, inguinal lymph node dissection does not guarantee survival, with a 5-year recurrence-free rate of 75% to 95%.[sup.38,39] While inguinal lymph node involvement is one of the strongest predictors in penile cancer, inguinal lymph node dissection must be weighed against the resulting morbidity, including infection, wound necrosis, and chronic leg edema.
Individuals predicted as high risk of lymph node involvement can undergo early inguinal lymph node dissection, while those predicted to be at lower risk can opt for ongoing surveillance.
Modified inguinal lymph node dissection has been proposed to minimize morbidity, while maintaining therapeutic benefit.[sup.65] A recent analysis assessed the impact of modified inguinal lymph node dissection on morbidity and survival.[sup.66] The authors concluded that the extent of lymph node dissection should be adapted to clinical stage, as this corresponds to metastatic spread.
Radical scrotal orchiectomy with or without an inguinal lymph node dissection was carried out in four cases (cases 2, 4, 5 and 6), and two patients were treated with a local tumour resection (cases 1 and 3).