Sentinel lymph node biopsy in patients with malignant melanoma: analysis of post‐operative complications

Abstract

Background: This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. Methods: A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. Results: Fifty-five post-operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow <1 mm) and in 68 of 262 (25.9%) patients with Breslow >1 mm. Conclusion: For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post-operative morbidity of almost 10% of SLNB highlights the need for careful patient selection.

Percutaneous contrast-enhanced ultrasound for localization and qualitative diagnosis of sentinel lymph nodes in cutaneous malignant melanoma of lower extremities: a preliminary study

“…The standard protocol for SLNB involves preoperative lymphoscintigraphy using an injection of radiocolloid, followed by intraoperative LN mapping using blue dye. According to reports in the literature, blue dye and radiocolloid particles can pass through the first echelon LNs due to their small size (20), leading to more extensive dissection and increased complications (27). Blue dye is often avoided in facial melanoma for esthetic and surgical reasons (28).…”

Incidence and risk factor analysis of complications after sentinel node biopsy for penile cancer

“…Predictors included age, body mass index (BMI), diabetes, smoking status, number of previously undergone surgeries in the groin, ASA classification, delayed DSNB, type of DSNB protocol (1 or 2 day), administration of prophylactic antibiotics before surgery, number of removed LNs (histopathology) and presence of SN metastasis. Pre-selection of variables was based on possible clinical relevance and/or previously described associations with the occurrence of postoperative complications after inguinal lymphadenectomy and DSNB in other malignancies [5,[18][19][20][21][22]. It is more likely that the risk of postoperative complications is similar within one patient and as several patients underwent multiple DSNB procedures (multiple measurements), the generalised linear mixed model included the 'patients' variable as a random effect with random intercept to correct for the non-independence of the data.…”

Proposed quality performance indicators of sentinel lymph node biopsy for cutaneous melanoma

“…The 13.7% complication rate in our study is comparable to other papers with rates ranging from 9.5% to 25%; Moody et al . conducted a systematic review in 2016 identifying an average complication rate of 11.3% across 21 studies 17,27,32,40–42 . Consistently across all research, the most frequently observed complications after a SLNB were wound infection and seroma formation.…”

“…Lymphoedema: Excess accumulation of lymphatic fluid in a limb due to lymphatic system insufficiency after surgery, resulting in localized swelling 16 Bleeding/haematoma: Unexpected blood loss during the post‐operative period and/or a localized collection of blood at the surgical site 17 Graft failure: Unsuccessful adherence of the graft to the wound site and/or failure of revascularisation 18 …”