Videoscopic Versus Open Inguinal Lymphadenectomy for Cancer
Patients with melanoma, some other rare skin cancers, and some cancers of the penis and scrotum can have their cancer spread to the lymph nodes in the upper part of the leg, called the groin. Medically, this area is called the inguinal area. At present, for melanomas and skin cancers this type of spread is usually found with a special test called a "sentinel lymph node biopsy". This procedure can find spread of even a few cells in a single lymph node—allowing the treating doctor to find the spread very early.
Treatment for patients with skin cancer in the lymph nodes in this area is to remove all of the lymph nodes in this area. In patients with cancers of the penis and scrotum who do hot have any evidence of cancer having spread either by physical examination or by radiology tests, the lymph nodes in this area are removed to check and see if there is cancer in them. This is called staging.
At present, the standard way to remove all of the lymph nodes in the groin is by a large incision, approximately 8-10 inches in length. For patients who have this operation, there is a very high incidence of infection after surgery: as many as 50% as patients can have a problem after surgery. These infections range from a low grade skin infection needing oral antibiotics to deep infections requiring the wound to be opened and occasionally needing readmission to the hospital and antibiotics given via the vein.
With the advent of new technology and new equipment, the ability to perform this procedure through small incisions away from the groin and further down the leg has become possible. This procedure has never been performed routinely nor compared side by side to the standard open approach. The investigators propose to perform this protocol in two phases.
The investigators have performed procedures in 20 groins to this point and have confirmed the number of lymph nodes and visually verified that the procedure is identical to the open procedure. The investigators performed these procedures in order to insure that the investigators were offering an equivalent option regardless of which procedure the patient is randomized to.
The study will involve the randomization of patients undergoing the procedure. The investigators will randomize the next 110 patients in a 2:1 fashion (two people will get the videoscopic procedure for every one who gets the open procedure) until 73 patients are included in the video arm and 37 in the open arm. Outcomes including recurrence rate, duration of drain requirements, and incidence of lymphedema will be followed. Patients will be followed using standard of care processes, including regular office visits, physical exams, and radiographic imaging, when indicated. Patients will be followed for 5 years.
|Melanoma Merkel Cell Carcinoma Squamous Cell Carcinoma Penile Carcinoma Urethral Carcinoma Extramammary Paget's Disease Scrotal Carcinoma Anal Cancer Vulvar Cancer Skin Cancer Lymphadenopathy||Procedure: Videoscopic procedure Procedure: Open, traditional approach|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||Videoscopic Versus Open Inguinal Lymphadenectomy for Sentinel Node Positive Cutaneous Malignancies and Genitourinary Staging Procedures|
- Complication profile [ Time Frame: 30 days ]The primary objective is to assess wound infection, wound dehiscence and other wound complications.
- Length of stay [ Time Frame: 1- 7 days ]Hospital length of stay.
- Lymphedema [ Time Frame: 5 years ]Assessment of lymphedema will be determined in all patients to identify if there is a difference in all patients undergoing either videoscopic or open inguinal lymphadenectomy.
- Nodal yield [ Time Frame: 5-7 days post procedure ]This will characterize, as a surrogate of completeness of surgery, the number of nodes retrieved at the surgical procedure via either approach.
- Readmission [ Time Frame: 30 days ]To assess differences in readmission rates between the two groups.
- Oncologic outcomes--survival [ Time Frame: 5 years ]Recurrence free and overall survival will be measured in patients undergoing the procedure to determine if the procedure impacts survival at all.
|Study Start Date:||June 2009|
|Study Completion Date:||February 2013|
|Primary Completion Date:||February 2013 (Final data collection date for primary outcome measure)|
Experimental: Videoscopic (Minimally invasive)
Patients in this arm will have the procedure done through the three port minimally invasive approach.
Procedure: Videoscopic procedure
Minimally invasive, three port approach, (using a laparoscope to perform a procedure previously performed through open surgery).
Active Comparator: Open (traditional approach)
Patients in this arm will have the traditional, open approach in conjunction with a sartorius muscle transposition.
Procedure: Open, traditional approach
Open surgical procedure, with sartorius muscle transfer.
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01526486
|United States, Georgia|
|Emory University Hospital-Winship Cancer Institute|
|Atlanta, Georgia, United States, 30322|
|Principal Investigator:||Keith Delman, MD||Emory University|