Early versus Delayed Complete Lymphadenectomy in Melanoma: Insight from MSLT I

Excerpt

In the December 2010 issue of Annals of Surgical Oncology, Faries et al. present their results from the first Multicenter Selective Lymphadenectomy Trial (MSLT I) regarding morbidity and length of stay for patients who underwent early versus delayed complete lymph node dissection (CLND) for melanoma.1 In MSLT I, 937 patients with primary melanoma were randomized to wide local excision (WLE) with sentinel lymph node (SLN) biopsy; early CLND was performed if lymph node metastasis was detected at the time of SLN biopsy. A total of 800 patients were randomized to WLE alone with postoperative observation of nodal basins; delayed CLND was performed if lymph node metastasis was detected by clinical examination during follow-up. Early CLND was performed in 225 patients, and at approximately 5 years of follow-up, 143 patients randomized to WLE alone have undergone delayed CLND (132 with complete data for analysis). Overall, the delayed CLND group demonstrated a statistically significant increase in rate of lymphedema compared with the early CLND group (20.4% vs. 12.4%; P = 0.04). In addition, there was a statistically significant increase in length of hospital stay for patients in the delayed CLND group versus the early CLND group (9.9 vs. 8.3 days; P = 0.021). This finding was hypothesized to result from a higher rate of superficial and deep inguinal lymph node dissection in the delayed CLND group (78%) compared with the early CLND group (42%) in which superficial inguinal dissection alone was more common; patients who underwent superficial and deep groin dissection had a longer length of stay compared with superficial groin dissection alone (13.9 vs. 10.2 days; P = 0.009). …