Groin Dissection in the Treatment of Lower-Extremity Melanoma Short-term and Long-term Morbidity

Baas, Peter C.; Koops, Heimen Schraffordt; Hoekstra, H.J.; Bruggen, J. J. van; Weele, L T van der; Oldhoff, J

doi:10.1001/archsurg.1992.01420030043008

Cited by 116 publications

(79 citation statements)

References 9 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. Global comparisons revealed that patients were 91% more likely to be identified with lymphedema (relative risk, 1.91; 95% confidence interval [CI], 1.71-2.12; P < .001) when they were enrolled in studies using objective measurement methods (ie, volume and circumference measures) than those enrolled in studies using subjective (eg, self-report or provider observation) assessments.…”

Section: Methods Of Lymphedema Assessmentmentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

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%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

170

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“…The finding of a positive SLN identify patients who might benefit from completion lymph node dissection (CLND) [4]. However, CLND carries significant morbidity [5] and [6] and there is no consensus on the benefit of a completion dissection in melanoma patients. In fact reports in the literature showed that only from 14 to 28% [7], [8], [9], [10] and [11] of positive patients will harbour further disease in the affected basin.…”

Section: Introductionmentioning

confidence: 99%

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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Dec 9. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for nonsentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Quaglino P, Ribero S, Osella-Abate S, Macrì L, Grassi M, Caliendo V, Asioli S, Sapino A, Macripò G, Savoia P, Bernengo MG.You may download, copy and otherwise use the AAM for non-commercial purposes provided that your license is limited by the following restrictions:(1) You may use this AAM for non-commercial purposes only under the terms of the CC-BY-NC-ND license.(2) The integrity of the work and identification of the author, copyright owner, and publisher must be preserved in any copy. AbstractObjective: Completion Lymph Node Dissection (CLND) is the current standard of practice for patients with a positive Sentinel Lymph Node Biopsy (SLNB). Significant morbidity is associated to CLND, so we tried to evaluate which prognostic variables could predict NSLN invasion in SLN-positive patients and their impact on the overall survival (OS). Methods: A retrospective chart review of 603 patients that had undergone SLNB for melanoma between 2000 and 2009 at our department was done. 100 SLN were positive at the histopathological analysis of SLN. Demographic variables, primary melanoma, SLN pathologic features and results of CLND were analysed. Multivariate logistic regression and OS analyses were carried out to test the prognostic relevance of clinicopathologic variables on CLND results and disease course. Results: Breslow thickness, ulceration and micro/macrometastatic pattern of SLN invasion carried a significantly independent higher likelihood of NSLN involvement; Starz classification did not maintain a statistical significance in multivariate analysis. Only one patient (4.3%) without adverse prognostic factors showed NSLN involvement, which was found in 33.3% of patients with one and 55.9% with two or more adverse parameters (p = 0.0001). OS analyses confirmed the prognostic significance of these factors. Conclusion: Waiting for the results of Multicenter Selective Lymphadenectomy Trial II, our study suggests a clinically useful and easily applicable means of identifying patients with an unfavourable disease course. The presence of one or more adverse factors identifies patients in whom CLND is mandatory to include thereafter in a more strict follow-up program. Moreover, the finding of no adverse prognostic indicators associated to the presence of significant co-morbidities and/or elderly age, could be useful in identifying patients not to treat by CLND.

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“…The pelvic nodes were approached extraperitoneally through a lower abdominal wall incision following the technique described by Baas et al 23 Axillary dissection comprised dissection of levels I-III.…”

Section: Radical Lymph Node Dissectionmentioning

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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Groin Dissection in the Treatment of Lower-Extremity Melanoma Short-term and Long-term Morbidity

Cited by 116 publications

References 9 publications

Lymphedema beyond breast cancer

Lymphedema beyond breast cancer

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

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

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