Timing of completion lymphadenectomy after positive sentinel node biopsy in patients with melanoma

Ophuis, Charlotte M.C. Oude; Akkooi, Alexander C. J. van; Rutkowski, Piotr; Powell, W.; Robert, Caroline; Testori, Alessandro; Leeuwen, Barbara L. van; Siegel, Petra; Eggermont, Alexander; Verhoef, Cornelis; Grünhagen, Dirk J.

doi:10.1002/bjs.10475

Cited by 6 publications

(9 citation statements)

References 23 publications

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“…Furthermore, the question, whether removing only the SLN is sufficient for disease control, is open. Previous studies showed that only 11.5–18.8% of patients undergoing CLND due to positive SLN have further positive lymph nodes . This supports the hypothesis that performing an SLNB ensures disease control.…”

Section: Discussionsupporting

confidence: 71%

“…Only patients with positive SLNB underwent CLND. Interestingly, studies showed that over 80% of patients who underwent CLND did not have any further positive lymph nodes . Additionally, recent randomized multicenter trials have suggested that performing a CLND does not significantly improve melanoma‐specific survival (MSS) but can only improve progression‐free survival (PFS).…”

Section: Introductionmentioning

confidence: 99%

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Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

Persa

Knuever

Mauch

et al. 2018

The Journal of Dermatology

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Although the role of sentinel lymph node biopsy (SLNB) as a prognostic factor is well established, its consequences for therapy are controversial. The aim of this study was to analyze if complete lymph node dissection (CLND) in patients with more than one positive sentinel lymph node (SLN) significantly improves melanoma-specific survival (MSS) and progression-free survival (PFS). Medical records of patients who underwent SLNB between 2001 and 2016 at the University Hospital of Cologne were reviewed, and patients with positive SLN were identified. Patient and tumor characteristics, patterns of recurrence, progression-free and melanoma-specific survival were analyzed. Seventy-eight patients with multiple positive and 197 patients with one positive SLN were included in this study. Patients with multiple positive SLN had significantly more positive non-SLN compared with patients with only one positive SLN (26.9% vs 8.6%, P = 0.01). However, in the subgroup of patients with multiple positive SLN, CLND did not significantly improve MSS (mean MSS 95 vs 75 months, P = 0.5) and PFS (mean PFS 59 vs 68 months P = 0.167). CLND did not result in a significant improvement in PFS and MSS in patients with multiple positive SLN.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

Persa

Knuever

Mauch

et al. 2018

The Journal of Dermatology

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“…Unfortunately, details of complications were not available for all patients in the present series, so this aspect could not be evaluated. The timing of CLND after diagnosis of melanoma was not assessed in this study, but it has been demonstrated recently that this does not seem to influence tumour load, DFS or MSS.…”

Section: Discussionmentioning

confidence: 99%

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

Verver

Madu

Ophuis

et al. 2018

Journal of British 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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“…CLND did not influence CLND tumour load, DFS or MSS, which is in line with our results. 9 However, these studies need to be viewed in light of the changing landscape in managing patients with CM with micrometastases in the SLN, especially with respect to immune and targeted therapies. 24,25 Nonetheless, our study contributes robust evidence that the outcome of patients with CM is not affected by the timing of surgical procedures such as SLNB and CLND.…”

Section: Discussionmentioning

confidence: 99%

“…However, the intervals reported vary greatly between different datasets, and most studies state a time delay to SLNB after primary resection of at least 30 days or even longer. [6][7][8][9][10][11][12][13][14][15][16] By contrast, we set out to investigate whether patients benefit from keeping the time span between primary resection and SLNB or between SLNB and complete lymph node dissection (CLND) as short as possible. To do so, procedures taking place ≤ 7 days after primary resection or SLNB were defined as very early (VE)-SLNB and -CLND, respectively.…”

Section: Introductionmentioning

confidence: 99%

Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma?

Gambichler

Bünnemann

Scheel

et al. 2020

Clin. Exp. Dermatol.

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Background In patients with cutaneous melanoma (CM), the time span between resection of the primary tumour and sentinel lymph node biopsy (SLNB) as well as the subsequent interval between SLNB and complete lymph node dissection (CLND) varies greatly. Aim To determine whether very early timing of SLNB after resection of the primary tumour, or timing of CLND after SLNB affect the clinical outcome of patients with CM, compared with longer time intervals. Methods We compared the time spans between complete resection of the primary tumour and SLNB, and the interval between SLNB and CLND in a cohort of 896 patients with melanoma who had undergone SLNB. An interval between primary resection and SLNB or between SLNB and CLND of up to 7 days was classified as very early (VE‐SLNB and VE‐CLND, respectively). This time span was compared with intervals of > 7 days. Univariate and multivariate statistics were performed. Results VE‐SLNB was significantly associated with the presence of micrometastases. However, this was probably due to tumour thickness being significantly higher in patients with VE‐SLNB compared with patients with later SLNB. Importantly, VE‐SLNB was not significantly associated with disease relapse and VE‐CLND was not associated with melanoma‐specific death. Conclusions VE‐SLNB and VE‐CLND neither improved nor worsened the clinical outcome of patients. Thus, timing of SLNB and CLND has no influence on the overall clinical outcome of patients with melanoma. Our findings support the rational planning of lymph node surgery after resection of the primary tumour and provide help for effective patient counselling.

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Timing of completion lymphadenectomy after positive sentinel node biopsy in patients with melanoma

Abstract: The time interval between diagnosis of melanoma and CLND did not influence CLND tumour load, DFS or MSS.

Cited by 6 publications

References 23 publications

Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

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

Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma?

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