Sentinel lymph node biopsy in patients with malignant melanoma: analysis of post-operative complications.
Adult
Aged
Aged, 80 and over
Female
Humans
Incidence
Italy
/ epidemiology
Lymph Node Excision
/ adverse effects
Lymph Nodes
/ pathology
Lymphatic Metastasis
/ pathology
Lymphocele
/ etiology
Male
Melanoma
/ secondary
Middle Aged
Postoperative Complications
/ epidemiology
Retrospective Studies
Risk Factors
Sentinel Lymph Node Biopsy
/ adverse effects
Seroma
/ etiology
Skin Neoplasms
/ epidemiology
Surgical Wound Dehiscence
/ etiology
Surgical Wound Infection
/ etiology
Melanoma, Cutaneous Malignant
melanoma
post-operative complication
risk factor
sentinel lymph node biopsy
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
05
11
2018
revised:
15
05
2019
accepted:
11
06
2019
pubmed:
2
8
2019
medline:
2
9
2020
entrez:
2
8
2019
Statut:
ppublish
Résumé
This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. 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. 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1041-1044Informations de copyright
© 2019 Royal Australasian College of Surgeons.
Références
AIOM Working Group; AIRTUM Working Group. I numeri del cancro in Italia. 2016. [Cited 2 Feb 2017.] Available from URL: http://www.registri-tumori.it/PDF/AIOM2016/I_numeri_del_cancro_2016.pdf
Morton DL, Wen DR, Cochran AJ. Pathophysiology of regional lymph node metastases in early melanoma studied by intraoperative mapping of the cutaneous lymphatics. Second International Conference on Melanoma. Venice, Italy, 1989.
Balch CM, Soong SJ, Bartolucci AA et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann. Surg. 1996; 224: 255-63.
Love TP, Delman KA. Management of regional lymph node basins in melanoma. Ochsner J. 2010; 10: 99-107.
Morton DL, Thompson JF, Cochran AJ et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N. Engl. J. Med. 2014; 370: 599-609.
Morton DL, Cochran AJ, Thompson JF et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann. Surg. 2005; 242: 302-13.
Moody JA, Ali RF, Carbone AC, Singh S. Complications of sentinel lymph node biopsy for melanoma; a systematic review of the literature. Eur. J. Surg. Oncol. 2017; 43: 270-7.
Di Leo A, Piffer S, Ricci F. Surgical site infections in an Italian surgical ward: a prospective study. Surg. Infect. 2009; 10: 533-8.
Garza R, Skoracki R, Hock K, Povoski SP. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer 2017; 17: 468.
Balch CM, Gershenwald JE, Soong SJ et al. Final version of 2009 AJCC melanoma staging and classification. J. Clin. Oncol. 2009; 27: 6199-206.
McMasters KM, Reintgen DS, Ross MI. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann. Surg. Oncol. 2001; 8: 192-7.
Albertini JJ, Cruse CW, Rapaport D. Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanoma. Ann. Surg. 1996; 223: 217-24.
Leong SP. The role of sentinel lymph nodes in malignant melanoma. Surg. Clin. North Am. 2000; 80: 1741-57.
Reintgen D, Rapaport D, Tanabe KK, Ross M. Lymphatic mapping and sentinel node biopsy in patients with malignant melanoma. J. Fla. Med. Assoc. 1997; 84: 188-93.
Jansen L, Nieweg OE, Peterse JL, Hoefnagel CA, Olmos RA, Kroon BB. Reliability of sentinel lymph node biopsy for staging melanoma. Br. J. Surg. 2000; 87: 484-9.
Duvernay A, Henault B, Danino MA. Complications associated with sentinel lymph node biopsy for cutaneous melanoma. A retrospective study of 127 patients. Ann. Chir. Plast. Esthet. 2012; 57: 151-7.
Wasserberg N, Tulchinsky H, Schachter J, Feinmesser M, Gutman H. Sentinel-lymph-node biopsy (SLNB) for melanoma is not complication-free. Eur. J. Surg. Oncol. 2004; 30: 851-6.
Kretschmer L, Thoms KM, Peeters S, Haenssle H, Bertsch HP, Emmert S. Postoperative morbidity of lymph node excision for cutaneous melanoma-sentinel lymphonodectomy versus complete regional lymph node dissection. Melanoma Res. 2008; 18: 16-21.
Coit DG, Thompson JA, Algazi A et al. Melanoma, version 2.2016, NCCN clinical practice guidelines in oncology. J. Natl. Compr. Canc. Netw. 2016; 14: 450-73.
National Comprehensive Cancer Network. NCCN Guidelines: Melanoma (Version 2.2018). 2018. [Cited 1 Apr 2018.] Available from URL: https://www.nccn.org/professionals/physician_gls/default.aspx