Background. Although postoperative complications are common after lymph node dissection, its association with disease recurrence has not yet been fully investigated. Methods. A retrospective review of a prospectively maintained database was conducted, looking at all malignant melanoma patients with sentinel nodes positive disease requiring axillary or inguinal dissection between 2002 and 2011. Results. A total of 124 patients required nodal clearance from 317 patients with stage I/II malignant melanoma who had undergone sentinel lymph node biopsy. Of these, 104 patients met the inclusion criteria and were divided into inguinal lymph node dissections (ILND; ) or axillary lymph node dissections (ALND; ). Immunohistochemical deposits had higher detection rate in ALND ( ). The ILND patients had a higher recurrence rate (84.1% versus 63.4%; ) and mortality (68.3% versus 48.8%; ) without a significant difference in complications. In patients whom complications developed, 75% of the ILND group and 71.4% of the ALND group had disease recurrence, but without reaching a statistical value as an independent predictor of melanoma recurrence. Conclusion. Complications are common following ILND and ALND; however there is no significant difference in complications rates between the groups with some associations with recurrence without reaching a significant difference. 1. Introduction Malignant melanoma has a unique position in the surgical and oncological fields as it is responsible for 79% of mortalities despite representing less than 5% of cutaneous malignancies [1]. The considerable variation in recurrence and survival rates among melanoma patients has motivated many researchers to look at different variables and risk factors that could predict prognosis. Morton et al. revolutionised the management of malignant melanomas in early 1990s by developing the sentinel lymph node biopsy (SLNB) technique, an important landmark in the management of clinical stage I and II cutaneous melanoma [2]. As a result, the Multicentre Selective Lymphadenectomy Trial (MSLT) was initiated [3]. This trial has shown that the presence of metastases in the sentinel node was the most important prognostic factor and has recommended completion lymph node dissection for patients with a positive SLNB [3]. There are several histopathological features that predict recurrence and survival, including the Breslow’s thickness, the presence of ulceration, and the mitotic rate [4]. Age, sex, presence of lymphovascular invasion and SLN status are other recognised risk factors [5]. The impact of the
References
[1]
A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu, and M. J. Thun, “Cancer statistics, 2009,” CA: A Cancer Journal for Clinicians, vol. 59, no. 4, pp. 225–249, 2009.
[2]
D. L. Morton, D. R. Wen, J. H. Wong et al., “Technical details of intraoperative lymphatic mapping for early stage melanoma,” Archives of Surgery, vol. 127, no. 4, pp. 392–399, 1992.
[3]
D. L. Morton, J. F. Thompson, A. J. Cochran, et al., “Sentinel-node biopsy or nodal observation in melanoma,” The New England Journal of Medicine, vol. 355, no. 13, pp. 1307–1317, 2006.
[4]
E. M？nsson-Brahme, J. Carstensen, K. Erhardt, et al., “Prognostic factors in thin cutaneous malignant melanoma,” Cancer, vol. 73, no. 9, pp. 2324–2332, 2006.
[5]
J. E. Gershenwald, W. Thompson, P. F. Mansfield et al., “Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients,” Journal of Clinical Oncology, vol. 17, no. 3, pp. 976–983, 1999.
[6]
C. M. Balch, S. J. Soong, A. A. Bartolucci 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,” Annals of Surgery, vol. 224, no. 3, pp. 255–266, 1996.
[7]
C. Garbe, P. Büttner, J. Bertz, et al., “Primary cutaneous melanoma. Prognostic classification of anatomic location,” Cancer, vol. 75, no. 10, pp. 2492–2498, 1995.
[8]
L. Schuchter, D. J. Schultz, M. Synnestvedt et al., “A prognostic model for predicting 10-year survival in patients with primary melanoma,” Annals of Internal Medicine, vol. 125, no. 5, pp. 369–375, 1996.
[9]
C. M. Balch, J. E. Gershenwald, S. J. Soong et al., “Multivariate analysis of prognostic factors among 2,313 patients with stage III melanoma: comparison of nodal micrometastases versus macrometastases,” Journal of Clinical Oncology, vol. 28, no. 14, pp. 2452–2459, 2010.
[10]
G. G. Callender, M. E. Egger, A. L. Burton, et al., “Prognostic implications of anatomic location of primary cutaneous melanoma of 1？mm or thicker,” The American Journal of Surgery, vol. 202, no. 6, pp. 659–665, 2011.
[11]
M. B. Faries, J. F. Thompson, A. Cochran et al., “The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the multicenter selective lymphadenectomy trial (I),” Annals of Surgical Oncology, vol. 17, no. 12, pp. 3324–3329, 2010.
[12]
W. R. Wrightson, S. L. Wong, M. J. Edwards et al., “Complications associated with sentinel lymph node biopsy for melanoma,” Annals of Surgical Oncology, vol. 10, no. 6, pp. 676–680, 2003.
[13]
N. Wasserberg, H. Tulchinsky, J. Schachter, M. Feinmesser, and H. Gutman, “Sentinel-lymph-node biopsy (SLNB) for melanoma is not complication-free,” European Journal of Surgical Oncology, vol. 30, no. 8, pp. 851–856, 2004.
[14]
D. G. Baker, T. M. Masterson, R. Pace, W. C. Constable, and H. Wanebo, “The influence of the surgical wound on local tumor recurrence,” Surgery, vol. 106, no. 3, pp. 525–532, 1989.
[15]
S. O. P. Hofer, D. Shrayer, J. S. Reichner, H. J. Hoekstra, and H. J. Wanebo, “Wound-induced tumor progression: a probable role in recurrence after tumor resection,” Archives of Surgery, vol. 133, no. 4, pp. 383–389, 1998.
[16]
R. Berguer, N. Bravo, M. Bowyer, C. Egan, T. Knolmayer, and D. Ferrick, “Major surgery suppresses maximal production of helper T-cell type 1 cytokines without potentiating the release of helper T-cell type 2 cytokines,” Archives of Surgery, vol. 134, no. 5, pp. 540–544, 1999.
[17]
J. C. Coffey, J. H. Wang, M. J. F. Smith, D. Bouchier-Hayes, T. G. Cotter, and H. P. Redmond, “Excisional surgery for cancer cure: therapy at a cost,” The Lancet Oncology, vol. 4, no. 12, pp. 760–768, 2003.
[18]
B. L. Andersen, C. L. Shapiro, W. B. Farrar, T. Crespin, and S. Welis-DiGregorio, “Psychological responses to cancer recurrence,” Cancer, vol. 104, no. 7, pp. 1540–1547, 2005.
[19]
K. L. Kilbridge, J. C. Weeks, A. J. Sober et al., “Patient preferences for adjuvant interferon alfa-2b treatment,” Journal of Clinical Oncology, vol. 19, no. 3, pp. 812–823, 2001.
[20]
N. Cascinelli, A. Morabito, M. Santinami, R. M. Mackie, and F. Belli, “Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial,” The Lancet, vol. 351, no. 9105, pp. 793–796, 1998.
[21]
A. A. Sarnaik, C. A. Puleo, J. S. Zager, and V. K. Sondak, “Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma,” Cancer Control, vol. 16, no. 3, pp. 240–247, 2009.
[22]
M. De Vries, H. J. Hoekstra, and J. E. H. M. Hoekstra-Weebers, “Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma,” Annals of Surgical Oncology, vol. 16, no. 10, pp. 2840–2847, 2009.
[23]
T. M. D. Hughes, R. P. A'Hern, and J. M. Thomas, “Prognosis and surgical mananagement of patients with palpable inguinal lymph node metastases from melanoma,” British Journal of Surgery, vol. 87, no. 7, pp. 892–901, 2000.
[24]
S. E. Singletary, R. Shallenberger, and V. F. Guinee, “Surgical management of groin nodal metastases from primary melanoma of the lower extremity,” Surgery Gynecology and Obstetrics, vol. 174, no. 3, pp. 195–200, 1992.
[25]
C. P. Karakousis, M. A. Heiser, and R. H. Moore, “Lymphedema after groin dissection,” The American Journal of Surgery, vol. 145, no. 2, pp. 205–208, 1983.
[26]
C. P. Karakousis, “Therapeutic node dissections in malignant melanoma,” Annals of Surgical Oncology, vol. 5, no. 6, pp. 473–482, 1998.
[27]
C. P. Karakousis, M. A. Hena, L. J. Emrich, and D. L. Driscoll, “Axillary node dissection in malignant melanoma: results and complications,” Surgery, vol. 108, no. 1, pp. 10–17, 1990.
[28]
C. R. Rayner, “The results of node resection for clinically enlarged lymph nodes in malignant melanoma,” British Journal of Plastic Surgery, vol. 34, no. 2, pp. 152–156, 1981.
