Surgeons’ Opinions on Lymphadenectomy in Melanoma Patients with Positive Sentinel Nodes: A Worldwide Web-Based Survey

Pasquali, Sandro; Spillane, Andrew J.; Wilt, Johannes H. W. de; McCaffery, Kirsten; Róssi, Carlo; Quinn, Michael J.; Saw, Robyn P.M.; Shannon, Kerwin F.; Stretch, Jonathan R.; Thompson, John F.

doi:10.1245/s10434-012-2483-3

Cited by 44 publications

(31 citation statements)

References 49 publications

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“…While CLND after positive SNB remains standard treatment in melanoma, there has been increasing debate about whether all patients with positive SNB should undergo CLND (12, 15, 19-21). In theory, CLND would only potentially benefit patients with additional tumor cells in the same nodal basin as the biopsied sentinel nodes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Lee

Lau

Huynh

et al. 2016

Journal of the American College of Surgeons

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Background The need for complete lymph node dissection (CLND) in patients with positive sentinel lymph node biopsy (SNB) is an important unanswered clinical question. Study Design Patients diagnosed with positive SNB at a melanoma referral center from 1991 to 2013 were studied. Outcomes of patients who underwent CLND were compared to those who did not undergo immediate CLND (observation group, OBS). Results There were 471 patients who had positive SNB; 375 (79.6%) in the CLND group and 96 (20.4%) in the OBS group. The groups were similar except that the CLND group was younger and had more sentinel nodes removed. Five-year nodal recurrence free survival was significantly better in the CLND group compared to the OBS group (93.1% vs 84.4%, p= 0.005). However, the 5- (66.4% vs 55.2%) and 10- year (59.5% vs 45.0%) distant metastasis free survival was not significantly different (p= 0.061). The CLND group's melanoma specific survival (MSS) was superior to the OBS group; 5 year MSS was (73.7 vs 65.5%) and10 year MSS- (66.8 vs 48.3%, p=0.015). On multivariate analysis, CLND was associated with improved MSS (HR 0.60, 95% CI 0.40-0.89, p= 0.011) and lower nodal recurrence (HR 0.46, 95% CI 0.24-0.86, p=0.016). Increased Breslow thickness, older age, ulceration, and trunk melanoma were all associated with worse outcomes. On subgroup analysis, following factors were associated with better outcomes from CLND- male gender, non-ulcerated primary, intermediate thickness, Clark level IV or lower extremity tumors. Conclusions Treatment of positive SNB with CLND was associated with improved MSS and nodal recurrence rate. Follow up beyond 5 years was needed to see a significant difference in MSS.

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Section: Discussionmentioning

confidence: 99%

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Lee

Lau

Huynh

et al. 2016

Journal of the American College of Surgeons

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“…Although evidence for a therapeutic benefit is still lacking pending the final results of Multicentre Selective Lymphadenectomy Trial (MSLT) II, many current melanoma guidelines advise consideration of completion lymphadenectomy (CLND) in case of a positive sentinel node biopsy (SNB). This is in line with the opinion of 91·8 per cent of 193 melanoma surgeons worldwide, but in practice only half of patients with a positive sentinel node (SN) actually undergo CLND. In the groin area, CLND can be classified as an inguinal dissection with removal of all femoral and inguinal lymph nodes, or an ilioinguinal dissection with additional removal of all iliac (up to the bifurcation of the common iliac artery) and obturator lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Optimal extent of completion lymphadenectomy for patients with melanoma and a positive sentinel node in the groin

Verver

Madu

Ophuis

et al. 2017

British Journal of Surgery

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BackgroundThe optimal extent of groin completion lymph node dissection (CLND) (inguinal or ilioinguinal dissection) in patients with melanoma is controversial. The aim of this study was to evaluate whether the extent of groin CLND after a positive sentinel node biopsy (SNB) is associated with improved outcome.MethodsData from all sentinel node‐positive patients who underwent groin CLND at four tertiary melanoma referral centres were retrieved retrospectively. Baseline patient and tumour characteristics were collected for descriptive statistics, survival analyses and Cox proportional hazards regression analyses.ResultsIn total, 255 patients were included, of whom 137 (53·7 per cent) underwent inguinal dissection and 118 (46·3 per cent) ilioinguinal dissection. The overall CLND positivity rate was 18·8 per cent; the inguinal positivity rate was 15·5 per cent and the pelvic positivity rate was 9·3 per cent. The pattern of recurrence, and 5‐year melanoma‐specific survival, disease‐free survival and distant‐metastasis free survival rates were similar for both dissection types, even for patients with a positive CLND result. Cox regression analysis showed that type of CLND was not associated with disease‐free or melanoma‐specific survival.ConclusionThere was no significant difference in recurrence pattern and survival rates between patients undergoing inguinal or ilioinguinal dissection after a positive SNB, even after stratification for a positive CLND result. An inguinal dissection is a safe first approach as CLND in patients with a positive SNB.

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“…More favorable morbidity has been reported with CLND in this setting versus therapeutic LND for clinically evident or recurrent disease . Although guidelines and surveys indicate that most surgical oncologists recommend lymphadenectomy for SLN‐positive melanoma patients , one population‐based study indicated that less than half of patients with a positive SLN went on to have a completion lymphadenectomy . Our study spanned 2000–2010 and 98.5% of our patients with a positive SLN underwent a CLND.…”

Section: Discussionmentioning

confidence: 84%

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

et al. 2016

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FS analysis for SLNs spared approximately half of patients a second operation. Patients with a positive SLN detected on FS were more likely to have further nodal involvement. In our experience intraoperative pathologic analysis of melanoma SLNs does not impair our ability to detect SLN metastasis or lead to a high rate of false positive results or nodal recurrences. J. Surg. Oncol. 2016;114:879-883. © 2016 2016 Wiley Periodicals, Inc.

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Surgeons’ Opinions on Lymphadenectomy in Melanoma Patients with Positive Sentinel Nodes: A Worldwide Web-Based Survey

Abstract: The majority of melanoma surgeons recommend CLND in SN-positive patients. Surgeons participating in the MSLT-2 suggest entering the trial to the majority of patients. More evidence is needed to standardize the extent of neck and groin CLND surgeries.

Cited by 44 publications

References 49 publications

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Impact of Completion Lymph Node Dissection on Patients with Positive Sentinel Lymph Node Biopsy in Melanoma

Optimal extent of completion lymphadenectomy for patients with melanoma and a positive sentinel node in the groin

Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation

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