We excluded 17 (10%) patients whose biopsies were conducted on more than one nodal basin under GA: according to the scintigraphic mapping, in 11 patients a bilateral axillary SN biopsy was required, in 3 a bilateral inguinal biopsy, and, in another 3 patients, an axillary and inguinal biopsy.
#Sentinel lymph node biopsy skin#
In the studied period, the data of 153 out of a total of 170 patients with skin melanoma in AJCC stages IB and II who underwent SN biopsy were recorded. We retrospectively analysed data of patients operated on, from July 2008 to March 2011. In this study, we limited the observations to recent cases, in order to have homogeneous groups of procedures, performed by the same surgical team, in the same facilities and well after the learning curve. Our group has been active in the field of surgical oncology since 1998, with more than 600 biopsies performed. The SN biopsy is offered to patients with malignant melanoma in AJCC stages IB and II.
and G.M.T.) according to National Comprehensive Cancer Network (NCCN) guidelines ( 2) and the Italian Association of Medical Oncology (AIOM) guidelines. SN biopsy is performed as standard procedure at the Perugia General Hospital and the Perugia University by surgeons of the Melanoma Multidisciplinary Group (P.C. The present retrospective study aimed to demonstrate the effectiveness and reliability of SN biopsy performed under LA and whether the LA procedure actually reduces costs and morbidity in comparison with the use of GA. This procedure is generally performed under general anaesthesia (GA), but several surgical groups have shifted from the use of GA to use of local anaesthesia (LA), because of advantages in terms of time, costs, hospitalisation period and reduction in morbidity ( 13, 14). The rise in incidence of melanoma, together with a more accurate definition of patient management, has led to a widespread increase of the number of SN biopsies carried out in western countries. The aim of this procedure is to reach optimal staging in patients with no evidence of nodal disease, hence optimizing therapeutic chances and obtaining prolonged regional disease control with minimal morbidity ( 8- 12). The presence of nodal metastasis greatly influences the prognosis of patients with cutaneous melanoma ( 3), and in American Joint Committee on Cancer (AJCC) stages I and II, sentinel node (SN) biopsy can be highly predictive of the status of the entire lymphatic basin ( 4- 7). In Italy, an annual average of 14.3 cases per 100,000 male-years and 13.6 cases per 100,000 female-years are registered ( 1) thus, melanoma has relevant social impact and economic consequences for the National Health System. The incidence of skin melanoma is continuously increasing in western countries for both sexes: in men more rapidly than for any other malignancy as well as in women, for which its incidence is exceeded only by lung cancer ( 1- 2). Conclusion: LA for groin and axillary SN biopsies can be a reliable and effective alternative to GA in melanoma patients, with shorter operating time, lower costs and without the side-effects and risks associated with GA. Operating time was significantly shorter under LA, with significantly lower costs. No difference was noted in the number of complications. Results: The mean number of removed SN was overall higher in the GA group but was not significantly different under LA with respect to the subgroups of axillary biopsies. Operations were carried out under LA in 112 cases (73%) and under GA in the remaining 41(27%). Patients and Methods: A retrospective analysis was carried out in 153 patients, evaluating the number of harvested lymph nodes, perioperative and postoperative complications, operating time and operating room costs, comparing interventions under LA and general anaesthesia (GA). Aim: The aim of our study was to evaluate feasibility, reliability and cost-benefit balance of sentinel node (SN) biopsies conducted under local anaesthesia (LA) in patients affected by stage I-B or II cutaneous melanoma.
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