Open ilio-obturator lymphadenectomy for stage III cutaneous malignancies – a retrospective case series on cases with concurrent inguinal lymphadenectomy and a case report on the laparoscopic transperitoneal approach

INTRODUCTION: Ilio-obturator lymphadenectomy (IOL) is used in the treatment of stage III melanoma. IOL can be performed using a conventional open approach, minimally invasive transperitoneal or extraperitoneal approach. IOL is traditionally combined with inguinal lymphadenectomy (IL). From 2010-2024, open IOL (O-IOL) was standard in our hospital. The first laparoscopic transperitoneal IOL (LT-IOL) for stage III melanoma we performed in our hospital, had a detrimental outcome. This prompted us to review our complications after O-IOL. The aim of this study is to assess surgical complication rates and safety of O-IOL when combined with IL. METHODS: This was a single-center retrospective case series on O-IOL with concurrent IL. Primary outcome measures were complication rates and severity, readmissions and surgical reinterventions. Secondary outcome measures were technique for surgical approach, unplanned visits and oncological outcome. RESULTS: Between 2010 and 2024, 11 patients underwent O-IOL combined with IL. One patient (9.1%) developed a surgical site infection after O-IOL, which was treated with antibiotics and outpatient wound debridement. No other complications were observed. All patients developed complications related to concurrent IL. CONCLUSIONS: O-IOL using a Rutherford-Morrison incision for the retroperitoneal approach shows low complication rates in this case series. In our described case, combining LT-IOL with IL resulted in a disastrous outcome.