Pilot Study of Immediate Lymphatic Reconstruction (ILR) During Lymph Node Dissection for Node‐Positive Melanoma: Feasibility, Safety, and Early Outcomes
Bibliographic record
Abstract
INTRODUCTION: Lymphedema (LE) is chronic swelling due to inadequate lymphatic function, which can occur after therapeutic lymph node dissection (TLND) for melanoma. At our institution, the risk of LE is 12% for axillary and 38% for ilioinguinal lymph node dissection. This study investigated LE rates in patients undergoing TLND with immediate lymphatic reconstruction (ILR) using lymphaticovenous anastomosis (LVA), a microsurgical technique aimed at preventing LE. METHODS: Patients with melanoma requiring TLND were recruited prospectively from the Tom Baker Cancer Center and were consented to undergo ILR at the time of their node dissection. Institutional ethics board approval was obtained (Ethics ID HREBA. cc-20-9426). This study was not a registered clinical trial; the ongoing randomized LYMbR trial (NCT05136079) is registered but does not include this cohort. The main objective was to assess the development of LE, which was defined as a 10% increase in postsurgical limb volume compared with the contralateral limb. In addition, participants completed the Lymphoedema Quality of Life Questionnaire (LYMQoL), a validated LE-specific quality of life patient-reported outcome measure (PROM) before surgery and at each 6-month assessment, to assess for any changes in quality of life related to LE. A direct comparison was made to historical institutional rates of LE after TLND without ILR. Kaplan-Meier analysis assessed overall survival and lymphedema-free survival, while Mann-Whitney U test compared quality of life between patients with and without lymphedema. RESULTS: Between August 2020 and October 2022, 22 patients (14 men and 8 women) with a median age of 68 (range 43-80) were included in the study and underwent TLND for melanoma with ILR. 16 patients underwent ALND, and 6 patients underwent ILND with ILR. There were no complications directly related to the ILR part of the procedure. All disease was at least stage III. At a median follow-up of 34 months (range: 0-51 months), three patients met the criteria for LE, one who underwent ALND and two ILND. Of these three patients, two had regional recurrence and one suffered from a DVT and a postoperative wound infection in the affected limb. LYMQoL scores were equal or better (p = NS) in patients without LE than those with LE across all domains except for mood: function (median IQR 1.0 vs 1.0, p = 0.78), appearance (1.0 vs 1.6, p = 0.19), symptom burden (1.1 vs 1.6, p = 0.52), and mood (1.1 vs 1.0, p = 0.87). CONCLUSION: This study aligns with other cohort studies demonstrating the usefulness of ILR in TLND patients with melanoma, which will be further examined in an ongoing randomized trial (LYMbR - NCT05136079).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".