Surgical technique of axillary, inguinal and iliac lymph node dissection

Background: Systematic lymph node dissection (SLND) plays an important role in the surgical treatment of many tumors. Despite continuous developments in surgical techniques, the morbidity in axillary, inguinal and iliac SLND remains high. Objective: Description of the currently existing surgical techniques of axillary, inguinal and iliac SLND with presentation of the possible advantages and disadvantages, also with respect to the oncological results. Material and methods: Based on the currently available literature reports, study results and own experience, the techniques of SLND and treatment results are presented. Results: SLND in the axillary, inguinal and iliac regions is still a challenging procedure for surgeons and patients. This problem exists due to the complex anatomy and the high morbidity. Modifications of open surgical techniques led to a reduction of postoperative complications only in rare exceptions. Minimally invasive iliac SLND is possible and can be performed both by laparoscopy and retroperitoneoscopy. The application of videoscopic techniques in axillary and inguinal SLND is also possible and the feasibility has been confirmed in different studies. Using minimally invasive approaches a significant reduction in wound complications could be achieved. Nevertheless, up to now the oncological results of minimally invasive surgery are still unclear, especially for malignant melanoma. Conclusion: By using minimally invasive SLND in the axillary, inguinal and iliac regions, a significant reduction of wound complications can be achieved. Further prospective studies are needed to confirm the initially promising results, especially with respect to the oncological outcome.