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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2010

01-12-2010 | Melanomas

The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I)

Authors: Mark B. Faries, MD, John F. Thompson, MD, Alistair Cochran, MD, Robert Elashoff, PhD, Edwin C. Glass, MD, Nicola Mozzillo, MD, Omgo E. Nieweg, MD, Daniel F. Roses, MD, Harold J. Hoekstra, MD, Constantine P. Karakousis, MD, Douglas S. Reintgen, MD, Brendon J. Coventry, BM, BS, PhD, He-Jing Wang, MD, Donald L. Morton, MD, for the MSLT Cooperative Group

Published in: Annals of Surgical Oncology | Issue 12/2010

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Abstract

Background

Complete lymph node dissection, the current standard treatment for nodal metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the basin. We hypothesized that early dissection would be associated with less morbidity than delayed dissection at the time of clinical recurrence.

Materials and Methods

The Multicenter Selective Lymphadenectomy Trial I randomized patients to wide excision of a primary melanoma with or without sentinel lymph node biopsy. Immediate completion lymph node dissection (early CLND) was performed when indicated in the SLN arm, while therapeutic dissection (delayed CLND) was performed at the time of clinical recurrence in the wide excision-alone arm. Acute and chronic morbidities were prospectively monitored.

Results

Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have undergone delayed CLND. The 2 groups were similar for primary tumor features, body mass index, basin location, and demographics except age, which were higher for delayed CLND. The number of nodes evaluated and the number of positive nodes was greater for delayed CLND. There was no significant difference in acute morbidity, but lymphedema was significantly higher in the delayed CLND group (20.4% vs. 12.4%, P = .04). Length of inpatient hospitalization was also longer for delayed CLND.

Conclusion

Immediate nodal treatment provides critical prognostic information and a likely therapeutic effect for those patients with nodal involvement. These data show that early CLND is also less likely to result in lymphedema.
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Metadata
Title
The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I)
Authors
Mark B. Faries, MD
John F. Thompson, MD
Alistair Cochran, MD
Robert Elashoff, PhD
Edwin C. Glass, MD
Nicola Mozzillo, MD
Omgo E. Nieweg, MD
Daniel F. Roses, MD
Harold J. Hoekstra, MD
Constantine P. Karakousis, MD
Douglas S. Reintgen, MD
Brendon J. Coventry, BM, BS, PhD
He-Jing Wang, MD
Donald L. Morton, MD
for the MSLT Cooperative Group
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1203-0

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