Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy Journal Article

Authors: Kingham, T.; Panageas, K. S.; Ariyan, C. E.; Busam, K. J.; Brady, M. S.; Coit, D. G.
Article Title: Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy
Abstract: Background: Completion lymph node dissection (CLND), although considered a standard approach for patients with melanoma and a positive sentinel lymph node (SLN), is not performed in as many as 50% of indicated cases. This study evaluates the outcome of patients who had a positive SLN but did not undergo CLND at Memorial Sloan-Kettering Cancer Center. Methods: A prospective database was used to identify all patients with a positive SLN from 1992 to 2008. Patient and tumor characteristics, number of positive SLNs, recurrence pattern, reason for not performing a CLND, and current status were evaluated. Results: There were 2269 patients who underwent SLN biopsy. Three hundred thirteen had a positive SLN, of whom 271 (87%) had a CLND and 42 (13%) did not. Patients in the no-CLND group were older (median age 70 vs. 56 years, P < .01), and had a trend toward thicker melanomas (3.5 vs. 2.8 mm, P < .06). A significantly higher percentage of no-CLND patients had lower-extremity melanomas (40% vs. 13% CLND; P < .01). The most common reason for not performing a CLND was patient refusal (45%). There were similar rates and patterns of recurrence between the two groups. Recurrence-free survival and disease-specific survival were also similar between the groups. Conclusions: It remains unclear whether CLND must be performed in all melanoma patients with a positive SLN. For selected informed patients who choose not to participate in the Multicenter Selective Lymphadenectomy Trial II trial, or in centers where the trial is not available, nodal observation may be an acceptable option. © 2009 Society of Surgical Oncology.
Keywords: adult; cancer survival; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; middle aged; survival rate; young adult; major clinical study; cancer recurrence; disease free survival; follow-up studies; lymph node metastasis; lymph node dissection; lymphatic metastasis; neoplasm staging; prospective study; sentinel lymph node; lymph node excision; prospective studies; sentinel lymph node biopsy; lymphadenectomy; melanoma; skin neoplasms; data base; patient identification; treatment refusal; leg
Journal Title: Annals of Surgical Oncology
Volume: 17
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2010-02-01
Start Page: 514
End Page: 520
Language: English
DOI: 10.1245/s10434-009-0836-3
PUBMED: 19924486
PROVIDER: scopus
PMCID: PMC4581428
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: ASONF" - "Source: Scopus"
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MSK Authors
  1. T Peter Kingham
    288 Kingham
  2. Katherine S Panageas
    329 Panageas
  3. Mary Sue Brady
    165 Brady
  4. Charlotte Eielson Ariyan
    78 Ariyan
  5. Daniel Coit
    421 Coit
  6. Klaus J Busam
    536 Busam