Routine retrieval of pelvic sentinel lymph nodes for melanoma rarely adds prognostic information or alters management

Swords, Douglas S.; Andtbacka, Robert H.I.; Bowles, Tawnya L.; Hyngstrom, John

doi:10.1097/cmr.0000000000000498

Cited by 3 publications

(11 citation statements)

References 24 publications

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“…We did not find poorer disease-free survival or higher local (groin) nodal recurrence rates in patients with drainage to PSLNs. Swords et al 10 and Vuoristo et al 11 reported similar findings. Karakousis et al 8 did not detect a difference in the pelvic recurrence rates, but found that drainage to PSLNs is associated with marginally lower disease-free survival if SSLNs were histologically negative.…”

Section: Discussionmentioning

confidence: 61%

“…Other predictive factors have been found to be older age, greater Breslow thickness, and melanoma subtype. 8–11 Regarding the melanoma positivity of PSLNs, it is associated with male sex, tumor thickness, melanoma subtype, location in feet, and higher radioactivity count of the node. 9,11 However, 30.8% of patients with PSLN had positive SSLN in SLNB, when patients without PSLN, the rate was 17.5%.…”

Section: Discussionmentioning

confidence: 99%

“…8 Studies that have also taken truncal melanomas into account have found percentages of between 8% and 69.8%. 9–12…”

Section: Introductionmentioning

confidence: 99%

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A role for pelvic sentinel lymph nodes in lower extremity melanoma?

et al. 2023

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Background and objective: Consensus on management of pelvic sentinel lymph nodes (PSLNs) has not been reached and thus the extent of sentinel lymph node biopsy (SLNB) of the groin in melanoma patients varies among centers and surgeons. Lymphatic drainage to PSLNs is often identified in, but the diagnostic and clinical relevance of PSLNs has been debated. Our aim was to determine if the presence of PSLNs affected recurrence or survival rates in patients with melanoma in the lower extremities. Methods: This retrospective study consisted of 702 patients with cutaneous melanoma operated between 2005 and 2018. Of these, 134 patients with melanoma in the lower extremities were included in the study. Images of lymphoscintigraphy and SPECT-CT studies were thoroughly observed together with surgery reports to define the status of SLNs. Results: Overall, 85 of 134 patients went through SLNB and 28 of them had PSLN identified. Two had their PSLN removed, which led 26 patients with PSLN to be compared to the 57 who did not have PSLN identified. We did not find statistically significant differences in overall recurrence (26.9% versus 28.0%, p = 1.00), regional nodal recurrence (11.5% versus 15.8%, p = 0.67), local or in-transit recurrence (19.2% versus 8.8%, p = 0.17), or distant recurrence rates (15.4% versus 19.3%, p = 0.66). Disease-free survival did not differ between the groups (median 23.0 (IQR 15.0–39.0) versus 19.0 (IQR 10.3–61.8) months, p = 0.82). Likewise, there was no statistically significant difference in melanoma-specific 5-year survival (78.6% versus 87.2%, p = 0.42). Conclusions: We did not find more frequent recurrence, shorter disease-free survival, or poorer melanoma-specific survival in patients with drainage to PSLN. Our findings strengthen the evidence that PSLNs should not be routinely biopsied if they are not the first-tier nodes.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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A role for pelvic sentinel lymph nodes in lower extremity melanoma?

et al. 2023

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“…Since there is no survival benefit and the impact on staging is minimal, what remains to justify routine retrieval of PSLNs? Creating precise criteria for harvesting pelvic lymph nodes warrants randomized controlled trials or at least a large multicentre retrospective study, as suggested by Swords and colleagues 8 . Although only few studies exist on the importance of PSLNs, they mostly agree on the very limited impact of PSLNs on staging and treatment of PSLNs 6–8 .…”

Section: Discussionmentioning

confidence: 99%

Pelvic sentinel lymph nodes have minimal impact on survival in melanoma patients

et al. 2021

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Background Lower limb or trunk melanoma often presents with femoral and pelvic sentinel lymph nodes (SLNs). The benefits of harvesting pelvic lymph nodes remain controversial. In this retrospective study, the frequency and predictors of pelvic SLNs (PSLNs), and the impact of PSLNs on survival and staging was investigated. Methods Altogether 285 patients with cutaneous melanoma located in the lower limb or trunk underwent sentinel lymph node biopsy of the inguinal/iliac lymph node basin at Helsinki University Hospital from 2009–2013. Patient characteristics, detailed pathology reports and follow-up data were retrieved from hospital files. Subgroups of patients categorized by presence of PSLNs were compared for outcome parameters including progression-free survival, melanoma-specific survival and groin recurrence. Results Superficial femoral/inguinal SLNs were present in all patients and 199 (69.8 per cent) also had PSLNs removed. Median number of SLNs per patient was five and median number of PSLNs was two. Sixty-three patients (22.1 per cent) had metastases in their SLNs and seven (2.5 per cent) had metastases in PSLNs. A single patient had metastases solely in PSLNs, while superficial SLNs remained negative. Harvesting PSLNs or the number of PSLNs retrieved had no impact on progression-free survival or overall survival. The removal of PSLNs did not affect the risk of postoperative seroma or lymphoedema. The only predictor of positive PSLNs was radioactivity count equal to or more than that of the hottest superficial SLNs. Conclusion Pelvic SLNs have minimal clinical impact on the outcome of melanoma patients especially in cases with negative superficial femoral/inguinal SLNs. Removal of PSLNs should be considered when they are the most radioactive nodes or equal to the hottest superficial femoral/inguinal SLNs in lymphoscintigraphy or during surgery. Preliminary results were presented in part at the International Sentinel Node Society Biennial Meeting, Tokyo, Japan, 11–13 October 2018.

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“…1,4 Several studies have attempted to identify factors that predict pelvic lymph node involvement, but no definitive relationships have been established. 4,5 The lack of predictive factors coupled with worse prognosis with pelvic node involvement forms the basis of the support for performing pelvic lymphadenectomy, albeit in select patients.…”

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confidence: 99%

Robotic-Assisted Pelvic Lymphadenectomy for Metastatic Melanoma Results in Durable Oncologic Outcomes

et al. 2019

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Background.-Robotic pelvic lymphadenectomy (rPLND) has been demonstrated to be a safe and effective minimally invasive approach for patients with metastatic melanoma to the iliac nodes. However, the long-term oncologic benefit of this procedure remains poorly defined.Methods.-A single-institutional study comparing perioperative outcomes and survival [recurrence-free (RFS) and overall survival (OS)] between rPLND and open PLND (oPLND) for metastatic melanoma was conducted.Results.-From 2006 to 2018, a total of 63 PLND cases were identified: 22 rPLND and 41 oPLND. Evidence of isolated pelvic metastasis was the most common indication for PLND in both groups (rPLND: 64%, oPLND: 85%). There was no difference in median pelvic lymph node yield (11 vs. 9 nodes, p = 0.65). Neither treatment group experienced a Clavien-Dindo complication ≥ 3. rPLND was associated with a shorter length of stay compared with oPLND (2 vs. 4 days, p < 0.001). With a median follow-up of 37 months, there was no difference in RFS (14.4 vs. 9.6 months, p = 0.47) and OS (43 vs. 50 months, p = 0.58) between rPLND and oPLND, respectively. In basin recurrence was low with 1 (4.5%) and 3 (7.3%) patients in the rPLND and oPLND cohorts, respectively, experiencing an event (p = 0.9).Conclusions.-rPLND for metastatic melanoma is a safe, minimally invasive treatment strategy that appears to result in similar intermediate term recurrence and survival rates as oPLND but shorter hospital stays.Management of pelvic lymph nodes in cutaneous melanoma is an ongoing area of debate. Many studies have investigated the relationship of inguinal lymph node involvement to pelvic lymph nodes. Pelvic lymph nodes are involved in approximately 10-15% of patients with clinically occult positive inguinal lymph nodes, which increases to 30% when there is palpable inguinal lymphadenopathy. [1][2][3] Studies also have found worse prognosis when J. S. Zager,

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Routine retrieval of pelvic sentinel lymph nodes for melanoma rarely adds prognostic information or alters management

Cited by 3 publications

References 24 publications

A role for pelvic sentinel lymph nodes in lower extremity melanoma?

A role for pelvic sentinel lymph nodes in lower extremity melanoma?

Pelvic sentinel lymph nodes have minimal impact on survival in melanoma patients

Robotic-Assisted Pelvic Lymphadenectomy for Metastatic Melanoma Results in Durable Oncologic Outcomes

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