Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases: Personal experience and literature meta-analysis

Sandro Pasquali, Simone Mocellin, Luca G. Campana, Elena Bonandini, Maria C. Montesco, Alberto Tregnaghi, Paolo Del Fiore, Donato Nitti, Carlo R. Rossi

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: It is debated whether patients with melanoma who undergo lymphadenectomy after a positive sentinel lymph node (SN) biopsy (SNB) have a better prognosis compared with patients who are treated for clinically evident disease. METHODS: The records of 190 patients with cutaneous melanoma who underwent radical lymph node dissection after a positive SNB (completion lymph node dissection [CLND]; n = 100) or who had clinically evident lymph node metastasis (therapeutic lymph node dissection [TLND]; n = 90) were analyzed. Moreover, the MEDLINE, EMBASE, and Cochrane databases were searched for studies that investigated the survival impact of SNB-guided CLND compared with TLND for clinically evident disease. Standard meta-analysis methods were used to calculate the overall treatment effect across eligible studies. RESULTS: In the authors' series, tumor characteristics did not differ significantly between patients who underwent CLND and those who underwent TLND. After a median follow-up of 52.6 months, the 5-year overall survival rate did not differ significantly between CLND patients and TLND patients (68.9% vs 50.4%, respectively; log-rank test; P = .17). In contrast, a meta-analysis of 6 studies (n = 2633) that addressed this issue (including the authors' own series) indicated that there was a significantly higher risk of death for patients who underwent TLND compared with that for patients who underwent CLND (hazard ratio, 1.60; 95% confidence interval, 1.28-2.00; P <.0001). CONCLUSIONS: Although no significant survival difference was observed in either series, the pooling of summary data from all the studies that dealt with this issue suggested that SNB-guided CLND is associated with a significantly better outcome compared with TLND for clinically evident lymph node disease.

Original languageEnglish
Pages (from-to)1201-1209
Number of pages9
JournalCancer
Volume116
Issue number5
DOIs
Publication statusPublished - Mar 1 2010

Keywords

  • Delayed lymph node dissection
  • Early lymph node dissection
  • Lymph node observation
  • Melanoma
  • Meta-analysis
  • Radical lymph node dissection
  • Sentinel lymph node biopsy
  • Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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