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Melanoma: rimozione dei linfonodi sì o no?

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Nel caso di pazienti con melanoma nei quali si trovano cellule maligne nel linfonodo “sentinella” non è necessario togliere anche i linfonodi vicini perché potrebbe aumentare il rischio di effetti avversi senza aumentare la sopravvivenza.

E’ stato dimostrato da uno studio internazionale a cui ha partecipato anche l’Istituto Pascale di Napoli, pubblicato dal New England Journal of Medicine.

I ricercatori hanno studiato circa 2mila pazienti, tutti con il linfonodo sentinella positivo, dividendoli in due gruppi.

Metà è stata trattata rimuovendo subito anche i linfonodi circostanti, mentre gli altri sono stati monitorati con un’ecografia ogni sei mesi, e sottoposti all’asportazione solo in caso di esito positivo.

La sopravvivenza è risultata identica nei due gruppi, ma nel primo è stato rivelato un tasso di effetti collaterali più alto, come ad esempio gonfiore, indurimento della pelle e difficoltà nel movimento.

“Abbiamo visto che in meno del 15% dei casi in realtà sarebbe necessaria l’asportazione di tutti i linfonodi – spiega Nicola Mozzillo, che ha diretto il gruppo napoletano che ha partecipato allo studio -. Applicare i risultati di questo studio al mondo reale porterebbe a una diminuzione considerevole degli interventi, risparmiando quindi al paziente effetti collaterali, conseguenze estetiche e psicologiche di un’operazione, e permettendo anche un utilizzo migliore delle risorse, visto che per il follow up i costi sono minimi”.

In Italia, spiega Mozzillo, sono circa 7mila i pazienti che sarebbero interessati, ma i numeri potrebbero crescere ulteriormente. “Lo studio è stato fatto per il melanoma – sottolinea l’esperto – ma lo stesso approccio è usato per molti altri tumori, a partire da quello della mammella, e stiamo cercando di verificare se si può applicare lo stesso principio. Questa è una rivoluzione per la chirurgia oncologica, da un approccio invasivo uguale per tutti ad una medicina di precisione tagliata sul paziente”.

Fonte: Ansa

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