Patient risk factors and surgical morbidity after regional lymphadenectomy in 204 melanoma patients

Abstract

A series of 204 melanoma patients were studied six months or longer after regional lymph node dissection of the neck (N = 48), axilla (N = 98) and groin (N = 58) in order to determine the degree of morbidity and analyze for risk factors associated with these procedures. Only one‐quarter of the patients experienced wound‐related, short‐term complications that were common at all sites; however, these rarely resulted in long‐term functional deficits. Seromas (22%), temporary nerve dysfunction or pain (14%), and wound infections (6%) were the most frequent short‐term complications. Wound complications extended the mean hospital stay by 0.6 to 4.8 days. Residual lymphedema of the leg was measurable in 26% of groin dissection patients after six months or longer; most of the edema was confined to the thigh. Only 8% of patients had significant functional deficit from lymphedema. The risk of developing at least one complication for all patients was increased for obese patients (P = 0.05) and increasing age (P =.01). These risk factors should be considered when evaluating melanoma patients for regional lymph node dissection.

Lymphedema beyond breast cancer

“…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.…”

“…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%).…”

“…Only Wolff et al reported mean follow-up (24 months), 24 and the study by Urist et al was the only 1 to use objective assessment measures (circumference). 20 The reported incidence of lymphedema ranged from 0% to 8%, and for the combined total of 139 patients, 4% were identified with lymphedema. The median quality score for these studies was 5 (range, 4-10).…”

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

“…1 The prevalence of complications and morbidity associated with dissection of RLNs can be high: 28-77%. [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.…”

The sentinel lymph node status is an important factor for predicting clinical outcome in patients with Stage I or II cutaneous melanoma

“…1 A significant disadvantage of the former is its redundancy-and its accompanying morbidity-if the regional lymph basin is not tumor-affected, which is the case in approximately 80% of the patients. 2,3 The disadvantage of a wait and watch approach is a poorer prognosis at the time that malignant lymph nodes become palpable during follow-up. 1,4 Over the years, studies have failed to offer a definitive solution to the issue of the optimal approach.…”