Lymph node dissection for melanoma using tumescence local anaesthesia: an observational study.

Area of Science:

• Oncology
• Surgical Oncology
• Anesthesiology

Background:

• The potential for tumescent local anesthesia (TLA) to cause tumor cell dissemination into lymph nodes remains uncertain.
• Understanding the impact of TLA versus general anesthesia (GA) on metastatic spread is crucial for melanoma patient management.

Purpose of the Study:

• To compare the influence of TLA and GA on lymph node metastasis and survival in melanoma patients undergoing complete lymph node dissection.
• To evaluate whether TLA infiltration affects metastatic spread and survival probability compared to GA.

Main Methods:

• A retrospective study included 281 melanoma patients with confirmed lymph node metastases.
• Patients were divided into two groups: those who received general anesthesia (GA, n=162) and tumescent local anesthesia (TLA, n=119).
• All patients underwent complete lymph node dissection, with a median follow-up of 70 months.

Main Results:

• The rate of lymph node recurrence at the dissection site was 25.3% for GA and 17.6% for TLA (p=0.082), showing a non-significant trend towards lower recurrence with TLA.
• No significant differences were observed in 10-year melanoma-specific survival, disease-free survival, or lymph node-free survival between the GA and TLA groups.
• Distant metastases-free survival was significantly reduced in the TLA group (64.0%) compared to the GA group (49.9%) (p=0.025).

Conclusions:

• Tumescent local anesthesia (TLA) does not appear to significantly increase the risk of lymph node recurrence or negatively impact overall and disease-free survival in melanoma patients compared to general anesthesia (GA).
• While overall survival and disease-free survival were comparable, a potential concern for reduced distant metastases-free survival warrants further investigation in the TLA group.
• The findings suggest that TLA may be a viable anesthetic option for melanoma patients undergoing lymph node dissection, but careful consideration of distant metastasis risk is needed.