van Robert Ginkel

Hyperthermic isolated limb perfusion in the management of extremity sarcoma

&NA; High local drug concentrations can be achieved in a limb with minimal systemic toxicity with the technique of hyperthermic isolated limb perfusion (HILP). The currently most successful drugs are still Tumor Necrosis Factor alpha (TNF&agr;) and melphalan. With HILP, as an induction chemotherapy treatment of locally advanced primarily irresectable soft tissue sarcomas of a limb, a limb salvage rate of 71% can be achieved, with a minimal treatment related morbidity. For the HILP is no upper age limit. Systemic inflammatory response syndrome is currently seldom seen. The exact working mechanisms of TNF&agr; are still unknown. Experimental work is now directed to the development of drugs sensitizing the tumor vasculature to the effects of TNF&agr;. In the clinical HILP setting are currently lower doses of TNF&agr; in combination with melphalan investigated. Although multidrug resistance (MDR) is a major issue in effectiveness of chemotherapy in human cancer treatment, HILPs with TNF&agr; and melphalan did not induce MDR in sarcomas. The future research in HILP with TNF&agr; is directed in increasing tumor sensitivity for TNF with lowering the dosage without decreasing tumor response.

Early mobilization after ilio-inguinal lymph node dissection for melanoma does not increase the wound complication rate

AIM Ilio-inguinal lymph node dissection for stage III melanoma is accompanied by a substantial amount of wound complications. Our treatment protocols changed in time in terms of postoperative bed rest prescriptions, being in chronological order Group A: 10 days with a Bohler Braun splint, Group B: 10 days without splint, and Group C: 5 days without splint. The aim of this study was to evaluate the effect of bed rest prescriptions on wound complications. METHODS For this study, we included all patients who underwent ilio-inguinal dissection for stage III melanoma in the period 1989-2011. Both univariate and multivariable analysis were performed to identify factors that were associated with occurrence of wound complications defined as wound infection, wound necrosis, and seroma. RESULTS Of the 204 patients analyzed, 99 suffered one or more wound complications: 51 wound infection, 29 wound necrosis, and 39 seroma. A wound complication occurred in 26 out of 64, 51 out of 89, and 22 out of 51 patients for Group A, B, and C, respectively. Univariate analysis showed age >55 (p = 0.001) and presence of comorbidity (p = 0.002) to be associated with higher incidence of wound complications. The 5 day bed rest protocol used in group C did not significantly increase the incidence of wound complications (ref = Group A: OR = 1.18; 95%CI = 0.52-2.68, p = 0.698). CONCLUSION Early mobilization did not significantly increase the overall wound complication rate after ilio-inguinal lymph node dissection for melanoma. Age >55 and comorbidity were risk factors in univariate analysis.