The influence of plastic techniques in surgery of primary skin melanoma on patient survival

S. A. Yargunin; Яргунин С. А.; Y. N. Shoyhet; Шойхет Я. Н.; A. F. Lazarev; Лазарев А. Ф.

doi:10.18821/1028-9984-2020-25-1-27-36

The influence of plastic techniques in surgery of primary skin melanoma on patient survival

Authors: Yargunin S.A.¹, Shoyhet Y.N.², Lazarev A.F.²
Affiliations:
1. Krasnodar cancer center #1
2. Altay State Medical University
Issue: Vol 25, No 1 (2020)
Pages: 27-36
Section: Clinical investigations
URL: https://rjonco.com/1028-9984/article/view/35117
DOI: https://doi.org/10.18821/1028-9984-2020-25-1-27-36
ID: 35117

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Abstract
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Abstract

Objective. To analyze the feasibility of performing plastic surgery in patients with primary skin melanoma (SM).

Material and methods. We studied patients with primary MK treated in our institution in 2013 (n = 333), who were randomized to a group of 2 blind selection methods to the main one (n = 168), in which the tumor removal operation in patients ended with a tissue defect repair and a comparison group ( n = 165) (after removal of the tumor, simple linear suturing of the wound was performed). A statistically significant difference was found in the comparison groups in the occurrence of negative dynamics (ND), progression-free survival (PFS) and overall survival (OS) in patients with MK 0-IIA st during the follow-up period up to 36 months.

Results. It was found that patients with 0-IIA st who underwent plastic surgery to close the defect when removing primary SM have a statistically proven advantage in ND, PFS, and OS compared with patients without plastic surgery for up to 36 months. In general, the use of plastics has a statistical tendency towards the dynamics of an increase in PFS and OS in the early stages of SM.

Discussion. In the early stages (0-IIA) up to 36 months, cases of negative dynamics (4.2%) were observed 2.3 times less frequently than in the comparison group (9.7%) (p = 0.048), and fatal outcomes in the main group (1.8%) were observed 3.7 times less than in the comparison group (6.7%) (p = 0.028). The analysis also shows that in patients who underwent surgery using plastic surgery statistically significantly reduces the risk of distant metastasis by 3 times (p = 0.05), but significantly more often (in every third patient) (p = 0.022) than in the control group (without plastic surgery) met transient metastases. The appearance of ND, as well as an increase in PFS, OS depended on the plastic replacement of the defect after excision of the primary SM in patients with SM 0-IIA st during the observation period up to 36 months.

Conclusion. The use of plastic methods for closing a wound defect reduces the risk of distant metastasis by 3 times compared with linear suturing, provides a reduction in mortality in patients with SM 0 – IIA st for 60 months, prolongs the patient’s life by an average of 10 months and is the operation of choice in this category.

Keywords

skin melanoma, surgical treatment, plastic replacement of a defect

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References

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2. Fig. 1. Negative dynamics in patients of the main (n = 168) and comparison (n = 165) groups by stages in the study period of time (in% of the total number of patients in the compared groups)