News Release: Emory Healthcare, Research, Winship Cancer Institute
Sep. 16, 2009
Doctors Testing Less Invasive Technique for Lymph Node Removal
Emory Winship Cancer InstituteA new surgical technique may reduce the risk of complications for patients fighting cancer who are having a lymph node biopsy in the groin area.
Doctors at Emory Winship Cancer Institute are testing a procedure for performing complete lymph node removal (inguino-femoral lymphadenectomy) through small incisions away from the groin, aided by videoscope.
"We are the only group performing this procedure for melanoma in the world," says Keith Delman MD, assistant professor of surgery at Emory University School of Medicine. "We have received a lot of interest from other surgeons in learning this technique. One main benefit may be in reducing the rate of infections."
Working together, Delman and Viraj Master, MD, PhD, assistant professor of urology at Emory School of Medicine, devised the less invasive procedure. The procedure is based on an example from surgeons in Brazil who performed a less comprehensive node dissection than done by the Emory group.
Patients with melanoma, other skin cancers and cancers of the genito-urinary system (penile, urethral, scrotal, vulvar) can have the cancer spread to the lymph nodes in the upper thigh and groin area. Treatment often requires taking out affected lymph nodes to prevent further spread.
Currently, the standard way to perform a lymph node biopsy or removal is with a large incision, approximately 8-10 inches in length. For patients who have this operation, there is a high rate of infection after surgery: up to 50 percent have some kind of infection, which in many cases can require wound reopening and intravenous antibiotics, and in the worst cases, necrosis of the skin flaps.
Another common complication after this type of surgery is lymphedema: problems in draining lymph fluid, resulting in swelling. Although some lymphedema after removing lymph nodes may be unavoidable, less disruption of the skin appears to result in no leg swelling at the current time, Delman says.
Delman and Master at Emory have performed 37 of this type of minimally invasive procedures so far. They are now beginning a clinical trial where the less invasive procedure is compared against the open procedure. Patients will be monitored for rates of complications such as infections and lymphedema.
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The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include schools of medicine, nursing, and public health; Yerkes National Primate Research Center; the Emory Winship Cancer Institute; and Emory Healthcare, the largest, most comprehensive health system in Georgia. The Woodruff Health Sciences Center has a $2.3 billion budget, 17,000 employees, 2,300 full-time and 1,900 affiliated faculty, 4,300 students and trainees, and a $4.9 billion economic impact on metro Atlanta.
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