Balancing survival with morbidity from lymphadenectomy

June 13, 2017

Abstract

Background

According to current guidelines, complete lymphadenectomy (LAD) is indicated in melanoma patients with a positive sentinel lymph node. Whereas there is little evidence from randomized trials for a survival benefit of this procedure, its morbidity is not trivial. We aimed to assess clinical associations between risk factors and complications of LAD to guide decision making about this aspect of melanoma management.

Methods and Results

A cohort of 174 patients who had undergone LAD for primary melanoma was retrospectively analyzed, and multivariable logistic regression models were used to correlate patient risk factors, tumor characteristics, number of excised lymph nodes, and procedural details with the incidence of complications. The overall rate of LAD-associated complications was 41.4%, 33.9% being lymphatic complications. The number of excised lymph nodes was independently associated with development of lymphatic complications (odds ratio 3.90/12.78 if more than 10/20 lymph nodes had been removed, p = 0.01/<0.001, respectively). However, the number of excised lymph nodes had no influence on overall survival using a multivariable Cox proportional hazards regression analysis.

Conclusions 

In this retrospective cohort study, an important association was found between the extent of LAD and lymphatic complications. Further studies should evaluate the necessity and extent of aggressive LAD to balance survival benefit with morbidity of LAD procedures.

Source:

Renner Philipp, Torzewski Maria, Zeman Florian, Babilas Philipp, Kroemer Alexander, Schlitt Hans J., and Dahlke Marc H. Increasing Morbidity with Extent of Lymphadenectomy for Primary Malignant Melanoma. Lymphatic Research and Biology. June 2017, 15(2): 146-152.https://doi.org/10.1089/lrb.2016.0018
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