Risk Factors for Complications and Long-Term Outcomes Following Completion Lymph Node Dissection for Cutaneous Melanoma: A Retrospective Cohort Study

Sars, Carl; Gillgren, Peter; Schultz, Inkeri; Lindqvist, Ebba K.

doi:10.1016/j.bjps.2020.02.038

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…Patients who did not have adjuvant treatment in the form of immunotherapy, chemotherapy, or radiotherapy within 6 months of CLND were excluded from this analysis which included 31 patients in total (Table 2). The most common complications after CLND in our cohort were lymphoedema, infection, and seroma, followed by wound dehiscence and other complications, as detailed previously [2]. The mean time to treatment between CLND and adjuvant treatment was 97 days.…”

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confidence: 58%

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Complications after surgery for malignant melanoma do not delay further treatment

et al. 2021

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confidence: 58%

“…Surgical complications after SNB occur in approximately 12% of patients and include seroma, wound infection, lymphoedema, hematoma, and nerve injury [ 1 ]. These complications may also occur after CLND, and the overall complication rate is significantly higher after this procedure due to its extensive nature [ 2 ].…”

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Complications after surgery for malignant melanoma do not delay further treatment

et al. 2021

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“…Other groups have also reported similarly high lymphedema rates for ILND [ 16 , 23 , 24 , 25 ]. Cormier and colleagues [ 16 ] pooled results from six melanoma studies and showed a lymphedema rate of 18% for ILND and 3% for ALND.…”

Section: Discussionmentioning

confidence: 67%

“…ILND confers a higher risk of lymphedema but also up to a ten-fold risk of overall post-operative complications [ 23 ]. Serpell et al [ 26 ] showed a higher rate of wound-related morbidity with ILND compared to ALND.…”

Section: Discussionmentioning

confidence: 99%

Higher Rate of Lymphedema with Inguinal versus Axillary Complete Lymph Node Dissection for Melanoma: A Potential Target for Immediate Lymphatic Reconstruction?

et al. 2022

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Background: The present study was conducted to define the lymphedema rate at our institution in patients undergoing axillary (ALND) or inguinal (ILND) lymph node dissection (LND) for melanoma. It aimed to examine risk factors predisposing patients to a higher rate of lymphedema, highlighting which patients could be targeted for immediate lymphatic reconstruction (ILR). Methods: A retrospective chart review was conducted between October 2015 and July 2020 to identify patients who had undergone ALND or ILND for melanoma. The main outcome measures were rates of transient and permanent lymphedema. Univariate and multivariate analyses were performed to assess the relationship between lymphedema rate and factors related to patient characteristics, surgical procedure, pathology findings, and adjuvant treatment. Results: Between October 2015 and July 2020, 66 patients underwent LND for melanoma: 34 patients underwent ALND and 32 patients underwent ILND. At a median follow-up of 29 months, 85.3% (n = 29) of patients having had an ALND did not experience lymphedema, versus 50.0% (n = 16) of ILND (p = 0.0019). The rates of permanent lymphedema for patients having undergone ALND and ILND were 11.8% (n = 4) and 37.5% (n = 12) respectively (p = 0.016, NS). The rate of transient lymphedema was 2.9% (n = 1) for ALND and 12.5% (n = 4) for ILND (p = 0.13, NS). On univariate analysis, the location of LND and wound infection were found to be significant factors for lymphedema. On multivariate analysis, only the location of LND remained a significant predictor, with the inguinal location predisposing to lymphedema. Conclusion: This study highlights the high rate of lymphedema following ILND for melanoma and is a potential target for future patients to be considered for ILR.

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“…[2][3][4] In previous studies, 11%-27% of SLNpositive patients had metastatic involvement in non-SLN, while the rest of the patients underwent CLND with no clear benefit but with the risks associated with surgical procedures and complications. [2][3][4][12][13][14][15] There was a reported benefit of local disease control with CLND. Also, patients with non-SLN involvement had a worse survival rate than non-SLN-negative patients, indicating CLND status as a significant prognostic factor in these patients.…”

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confidence: 99%

Regional lymph node metastases in cutaneous melanoma: a single-center analysis from southeast europe

et al. 2021

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Objective: Sentinel lymph node biopsy is the standard of care for nodal staging in clinically node-negative melanoma patients. Our goal was to present 10-year results of sentinel lymph node biopsy at our institution and to evaluate the clinicopathologic factors as potential predictors of sentinel lymph node and non-sentinel lymph node metastatic involvement in patients with cutaneous melanoma. Methods: We have analyzed clinicopathologic and lymphoscintigraphic characteristics in 420 patients with cutaneous melanoma who underwent sentinel lymph node biopsy between 2010 and 2019. In addition, we have examined the results of group of patients with positive sentinel lymph node biopsy undergoing complete lymph node dissection. Results: The overall detection rate of sentinel lymph node biopsies was 97.1%, of which 18.8% was metastatic. Drainage to one regional basin was seen in 345 patients (83.1%) and to multiple drainage regions in 71 patients (17%). In-transit lymph nodes were detected in 20 patients. On univariate logistic regression analysis, male gender, primary tumor thickness with nodular histology, acral location, presence of ulceration, and the number of nodes harvested were significantly associated with sentinel lymph node biopsy status ( p < 0.05). On multivariate analysis, the Breslow thickness was the only independent predictor of sentinel lymph node biopsy status. The metastases in non-sentinel lymph node found in 26 patients with positive sentinel lymph node (35.6%) correlated on univariate, as well as on multivariate logistic regression, with tumor subtype and number of sentinel lymph node harvested. Conclusion: In addition to the well-established primary tumor thickness as a predictor of sentinel lymph node biopsy positivity, we observed acral location and nodular melanoma subtype to significantly enhance the risk of metastases in sentinel lymph node(s). Primary tumor histology and number of nodes harvested were the only statistically significant variables predicting the non-sentinel lymph node status on multivariate analysis. Lymphoscintigraphy imaging characteristics were not significantly associated with sentinel lymph node status.

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Risk Factors for Complications and Long-Term Outcomes Following Completion Lymph Node Dissection for Cutaneous Melanoma: A Retrospective Cohort Study

Cited by 10 publications

References 25 publications

Complications after surgery for malignant melanoma do not delay further treatment

Complications after surgery for malignant melanoma do not delay further treatment

Higher Rate of Lymphedema with Inguinal versus Axillary Complete Lymph Node Dissection for Melanoma: A Potential Target for Immediate Lymphatic Reconstruction?

Regional lymph node metastases in cutaneous melanoma: a single-center analysis from southeast europe

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