Morbidity, mortality and local recurrence following regional node dissection for melanoma

Bowsher, W. G.; Taylor, Ben; Hughes, L. E.

doi:10.1002/bjs.1800731119

Cited by 107 publications

(46 citation statements)

References 8 publications

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“…16,18,20,22,[26][27][28] Two studies used water displacement methods exclusively for limb volume assessment, defining lymphedema thresholds of 6.5% and 10%, 29,30 and another 4 studies used both circumference and water displacement. 23,[31][32][33] More subjective assessments of lymphedema included the Common Toxicity Criteria and the Late Effects Normal Tissues Scales, 34,35 but the majority used ad hoc clinical grading to define lymphedema such as skin-pinch tests or scales defined by the treating physician.…”

Section: Methods Of Lymphedema Assessmentmentioning

confidence: 99%

“…Melanoma patients were then stratified into 2 groups according to the anatomic region in which lymph node dissection was performed (ie, axillary and inguinofemoral). Six studies included both patients who had undergone axillary or inguinofemoral lymph node dissections, [16][17][18][19][20][21] ; the dissection groups from these studies are listed separately in Table 1. The pooled incidence of lower extremity lymphedema after inguinofemoral lymph node dissection was higher (18%) than for upper extremity lymphedema after axillary lymph node dissection (3%).…”

Section: Type Of Malignancymentioning

confidence: 99%

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Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

402

170

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BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and followup interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n ¼ 15), gynecologic malignancies (n ¼ 22), genitourinary cancers (n ¼ 8), head/neck cancers (n ¼ 1), and sarcomas (n ¼ 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS: Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010;116:5138-49.

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Section: Methods Of Lymphedema Assessmentmentioning

confidence: 99%

Section: Type Of Malignancymentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

402

170

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“…In various reports there are complication rates of between 25% and 90%. 13,23,33,34 Dissection of the axillary region has been shown to be associated with a lower complication rate ranging from 4.6% up to 51%. 12,35,36 In our study, the complication rate for axillary dissection was 23.5%.…”

Section: -32mentioning

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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“…In the remaining cases, no tumor is found in the lymph nodes and these patients receive excessive treatment and are submitted to the risk of postoperative complications. [5][6][7][8][9][10][11] Balch et al characterized a subgroup of patients under 60 years old with tumor thickness of 1-4 mm who benefited from elective lymph node dissection. 12,13 The concept of sentinel lymph node (SN), the first node in the lymphatic basin that drains the area of the primary tumor, has changed the surgical approach in melanoma patients.…”

Section: Introductionmentioning

confidence: 99%

Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

et al. 2000

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a b s t r a c tCONTEXT: Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. OBJECTIVE:Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. DESIGN:Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. SETTING:Patients were seen at Hospital São Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology).PATIENTS: 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. INTERVENTIONS:Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD was performed on all patients. The SN was examined by conventional and immunohistochemical staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. MAIN MEASUREMENTS:The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. RESULTS:Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage in 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up = 11 months). CONCLUSION:Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins.

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Morbidity, mortality and local recurrence following regional node dissection for melanoma

Cited by 107 publications

References 8 publications

Lymphedema beyond breast cancer

Lymphedema beyond breast cancer

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

Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?

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