Morbidity and Recurrence After Completion Lymph Node Dissection Following Sentinel Lymph Node Biopsy in Cutaneous Malignant Melanoma

Guggenheim, Merlin; Hug, Urs; Jung, Florian; Rousson, Valentin; Aust, Matthias; Calcagni, Maurizio; Künzi, W.; Giovanoli, Pietro

doi:10.1097/sla.0b013e318161312a

Cited by 117 publications

(69 citation statements)

References 54 publications

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“…As a consequence, the majority of SLN-positive patients undergo unnecessary surgery associated with considerable morbidity (Guggenheim et al, 2008). Therefore, several authors have tried to identify patient, tumour and SLN characteristics predicting further non-SLN positivity to safely avoid CLND (Carlson et al, 2003;Van Akkooi et al, 2006;Scolyer et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

et al. 2008

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Twenty per cent of sentinel lymph node (SLN)-positive melanoma patients have positive non-SLN lymph nodes in completion lymph node dissection (CLND). We investigated SLN tumour load, non-sentinel positivity and disease-free survival (DFS) to assess whether certain patients could be spared CLND. Sentinel lymph node biopsy was performed on 392 patients between 1999 and 2005. Median observation period was 38.8 months. Sentinel lymph node tumour load did not predict non-SLN positivity: 30.8% of patients with SLN macrometastases (X2 mm) and 16.4% with micrometastases (p2 mm) had non-SLN positivity (P ¼ 0.09). Tumour recurrences after positive SLNs were more than twice as frequent for SLN macrometastases (51.3%) than for micrometastases (24.6%) (P ¼ 0.005). For patients with SLN micrometastases, the DFS analysis was worse (P ¼ 0.003) when comparing those with positive non-SLNs (60% recurrences) to those without (17.6% recurrences). This difference did not translate into significant differences in DFS: patients with SLN micrometastasis, either with (P ¼ 0.022) or without additional positive non-SLNs (Po0.0001), fared worse than patients with tumour-free SLNs. The 2-mm cutoff for SLN tumour load accurately predicts differences in DFS. Non-SLN positivity in CLND, however, cannot be predicted. Therefore, contrary to other studies, no recommendations concerning discontinuation of CLND based on SLN tumour load can be deduced.

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Section: Discussionmentioning

confidence: 99%

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

et al. 2008

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“…10,15 Groin dissections are, in general, associated with a greater prevalence of complications than axillary dissections, as demonstrated here and in other studies. 10,11 Patients with a high body mass index (>30 kg/m 2 ) undergoing inguinal dissection are at a greater risk of developing complications. 5,9 If undertaking groin dissections, some surgeons preserve the saphenous vein and may also transpose the sartorius muscle to provide more robust and reliable cover of inguinal vessels.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Groin dissections are typically associated with a higher prevalence of complications than axillary dissections. 2,[9][10][11][12] In 1992, Baas et al undertook a retrospective review of 151 consecutive groin dissections. They reported a prevalence of 17% for seroma, 9% for wound infection, 3% for wound necrosis, and 20% for wound oedema.…”

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confidence: 99%

Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes

Dickson

Davies

Rahman

et al. 2015

annals

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INTRODUCTION Dissection of regional lymph nodes (RLNs) can lead to significant morbidity and a high prevalence of complications. Published guidance states that these procedures should be carried out by surgeons who are members of a specialist skin multidisciplinary team who carry out a combined minimum of 15 axillary/groin dissections per year. However, there is little evidence to guide this minimum figure of procedures. We report on the burden of service provision and prevalence of complications across the South West of England and Wales. METHODS A 12-month review of dissections of RLNs for skin cancer was undertaken covering five Plastic Surgery Units with a collective catchment of 8.4 million people. Detailed data were collected on patient demographics, pathology, timing of surgery, and prevalence of complications. RESULTS A total of 163 dissections were carried out. Forty-three per cent of patients experienced one or more complication. In that 12-month period, an average of 8 axillary/groin dissections was carried out per surgeon. A funnel plot demonstrated that the prevalence of complications for individual surgeons was within the limit of the plot but, in many cases, this was based only on a relatively small number of procedures per consultant. If surgeons carried out 10 procedures per year, the upper and lower limits on the plot were 73% and 11%, respectively. CONCLUSIONS Funnel plots can provide a useful guide as to whether the prevalence of complications for procedures for individual surgeons lies within acceptable limits. Based on these results, 10 procedures per consultant per year should be sufficient to enable meaningful assessment of the prevalence of complications.

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“…Our morbidity rate is comparable with other studies on surgery for melanoma with reported rates of 19.9% to 51%. [9][10][11][12][13] However, these reports do not provide further patients' details except the primary tumour stage and, in some cases, the height, body weight and BMI. Other possible risk factors such as concomitant diseases are not mentioned.…”

Section: -32mentioning

confidence: 99%

“…There are several reports on factors influencing the morbidity rates such as the site of lymph node dissection (groin or axillary) and the body mass index (BMI) of the patients as well as the number of tumour-affected lymph nodes. [9][10][11][12][13] However, the reported morbidity rates are mostly based on multiple retrospective single institutional trials and vary widely. 14 Crude rates of morbidity and mortality after radical lymph node dissection do not allow an objective interpretation because the case mix and fitness of patients are not appropriately considered.…”

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confidence: 99%

Risk evaluation in cutaneous melanoma patients undergoing lymph node dissection: impact of POSSUM

Egberts

Hartje

Schafmayer

et al. 2011

annals

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INTRODUCTION When lymphatic metastasis occurs, surgery is the primary treatment modality in melanoma patients. Depending on the tumour stage, patients receive a completion lymph node dissection (CLND) when a positive sentinel node is detected. Patients with clinically evident disease of the regional lymph nodes are recommended to undergo a therapeutic lymph node dissection (TLND). The aim of this study was to assess the morbidity of CLND and TLND and to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) for preoperative risk adjustment of postoperative morbidity. METHODS The hospital files of 143 patients who underwent CLND and TLND for malignant melanoma were analysed. The POSSUM score was used to predict morbidity rates after surgery for the total patient group as well as separated for CLND and TLND patients. RESULTS The overall complication rate was 28.0% and the mortality rate was 0%. The morbidity rate predicted by POSSUM was 32.9%, the mortality 8.3%. Morbidity in patients undergoing CLND was significantly higher with regard to overall wound complications compared with patients with TLND. In these subgroups, POSSUM failed to predict the rates precisely. CONCLUSIONS The POSSUM score predicted the morbidity of the total patient group accurately but failed to predict the rates in the TLND and CLND subgroups. Patients receiving CLND showed the highest morbidity rates. Preoperative sentinel lymph node biopsy therefore has more influence on postoperative morbidity than the physiological parameters represented in the POSSUM physiological score.

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Morbidity and Recurrence After Completion Lymph Node Dissection Following Sentinel Lymph Node Biopsy in Cutaneous Malignant Melanoma

Cited by 117 publications

References 54 publications

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

The influence of sentinel lymph node tumour burden on additional lymph node involvement and disease-free survival in cutaneous melanoma – a retrospective analysis of 392 cases

Dissections of regional lymph nodes for treatment of skin cancer: predicting annual caseloads that will optimise outcomes

Risk evaluation in cutaneous melanoma patients undergoing lymph node dissection: impact of POSSUM

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