ASO Visual Abstract: Robot-Assisted Pelvic Dissection for Enlarged Lymph Nodes in Melanoma Improves Recovery with Equivalent Oncological Outcomes to Open Pelvic Dissection

Background Robot-assisted pelvic lymph node dissection (rPLND) has been reported in heterogenous groups of patients with melanoma, including macroscopic or at-high-risk-for microscopic metastasis. With changing indications for surgery in melanoma, and availability of effective systemic therapies, pelvic dissection is now performed for clinically detected bulky lymph node metastasis followed by adjuvant drug therapy. rPLND has not been compared with open pelvic lymph node dissection (oPLND) for modern practice. Methods All patients undergoing pelvic node dissection for macroscopic melanoma at a single institution were reviewed as a cohort, observational study. Results Twenty-two pelvic lymph node dissections were identified (8 oPLND; 14 rPLND). The number of pelvic lymph nodes removed was similar (median oPLND 6.5 (interquartile range [IQR] 6.0–12.5] versus rPLND 6.0 [3.75–9.0]), with frequent matted nodes (11/22, 50.0%). Operative time (median oPLND 130 min [IQR 95.5–182] versus rPLND 126 min [IQR 97.8–160]) and complications (Clavien-Dindo scale) were similar. Length of hospital stay (median 5.34 days (IQR 3.77–6.94) versus 1.98 days (IQR 1.39–3.50) and time to postoperative adjuvant therapy (median 11.6 weeks [IQR 10.6–18.5] versus 7.71 weeks [IQR 6.29–10.4]) were shorter in the rPLND group. No differences in pelvic lymph node recurrence ( p = 0.984), distant metastatic recurrence ( p = 0.678), or melanoma-specific survival ( p = 0.655) were seen (median follow-up 21.1 months [rPLND] and 25.7 months [oPLND]). Conclusions rPLND is an effective way to remove bulky pelvic lymph nodes in melanoma, with a shorter recovery and reduced interval to initiating adjuvant therapy compared with oPLND. This group of patients may especially benefit from neoadjuvant systemic approaches to management.