The superior cosmetic results of nipple-sparing mastectomies (NSMs) has been the primary factor driving the procedure’s wide dissemination; however, NSM for patients with deleterious BRCA mutations is controversial. As testing for hereditary cancer syndromes and NSM are simultaneously being used with increased frequency,^1,2 understanding the oncologic efficacy of this procedure is critical.

It has been clearly documented in colon cancer that the number of lymph nodes examined has prognostic significance, especially in stage II disease.^1-3 The pathologic evaluation of only a low number of lymph nodes has been shown to increase the risk of recurrence. Inadequate staging, especially for T3N0 lesions, is considered a high-risk marker and is taken into consideration when deciding on the benefit of adjuvant chemotherapy. Many patients are inaccurately diagnosed as having node-negative disease on the basis of a pathologic investigation of a suboptimal number of lymph nodes. What remains unknown and a point of intense contention is why some patients who undergo colon resection have a high lymph node count and others a low lymph node count. The surgeon, pathologist, and patient have all been held responsible for a low lymph node count. This study was designed to identify the factors that contribute to the disparity in the number of lymph nodes examined for curative colon cancer resections.

Background: Minimally invasive inguinal lymph node dissection (MILND) is a novel approach to inguinal lymphadenectomy. SAFE-MILND (NCT01500304) is a multicenter, phase I/II clinical trial evaluating the safety and feasibility of MILND for patients with melanoma in a group of surgeons newly adopting the procedure. Methods: Twelve melanoma surgeons from 10 institutions without any previous MILND experience, enrolled patients into a prospective study after completing specialized training including didactic lectures, participating in a hands-on cadaveric laboratory, and being provided an instructional DVD of the procedure. Complications and adverse postoperative events were graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events Version 4.0. Results: Eighty-seven patients underwent a MILND. Seventy-seven cases (88.5%) were completed via a minimally invasive approach. The median total inguinal lymph nodes pathologically examined (SLN + MILND) was 12.0 (interquartile range 8.0, 14.0). Overall, 71% of patients suffered an adverse event (AE); the majority of these were grades 1 and 2, with 26% of patients experiencing a grade 3 AE. No grade 4 or 5 AEs were observed. Conclusions: After a structured training program, high-volume melanoma surgeons adopted a novel surgical technique with a lymph node retrieval rate that met or exceeded current oncologic guidelines and published benchmarks, and a favorable morbidity profile.