Artikel
Hyperthermic Isolated Limb Perfusion for In-Transit Metastases of Malignant Melanoma: a save and feasible procedure also for high-risk patients
Suche in Medline nach
Autoren
-
Christian Gröger
- Charité Universitätsmedizin Berlin, Chirurgie, Berlin, Deutschland
| Veröffentlicht: | 21. April 2016 |
|---|
Gliederung
Text
Background: For patients with recurrent In-Transit Melanoma Metastases of the extremities the Hyperthermic Isolated Limb Perfusion (HILP) is an established treatment option. According to the German S3-Guidelines it should be considered in patients suffering from recurrent in-transit or local metastases. However, there are still ongoing discussions about the indications and technical aspects for this procedure.
Materials and methods: In this retrospective study we examined the perioperative course and follow-up for patients treated with Hyperthermic Isolated Limb Perfusion using Melphalan (Mel-HILP) for recurrent in-transit Metastases between December 2007 and December 2012 in our institution.
Results: Fifty-five patients were treated in our institution between December 2007 and December 2012. Of these patients 9 (16.4 %) were stage IV (AJCC 2002). The median age was 73 (29 – 90) years. ASA Score was III or higher in 39 (70.8 %) patients. In 3 patients the procedure was performed on the upper extremity. A systematic lymphadenectomy was performed in 40 (72.8 %) cases whereas 35 (63.6 %) already have had a regional lymphadenectomy in medical history. In 5 (9.1 %) patients a HILP was performed before.
We did not register any systemic toxicity. Two patients (3.6 %) suffered from dermatitis and one case of myositis was diagnosed. There were 7 (12.7 %) wound edge necrosis, 14 (15.5 %) wound healing disorders and 37 (67.2 %) lymphatic fistulas. In 9 (15.4 %) cases a surgical intervention was necessary. The wound drains were removed after 9 (1 – 80) days. There were no fasciotomies or amputations needed. The median hospital stay was 11 (5 – 57) days.
The local response rates after 3 and 6 month were 74.5 % and 43.6 % respectively. Local recurrences occurred in 69.1 % and distant metastases developed in 60.5 % of the patients. The median survival was 13.3 month (95 % KI, 11.1 to 15.6).
Conclusion: Hyperthermic Isolated Limb Perfusion with Melphalan (Mel-HILP) for patients with recurrent In-Transit Metastasis of the extremities is a save and feasible procedure also in complex patients.
