Risk evaluation in cutaneous melanoma patients undergoing lymph node dissection: impact of POSSUM
Identifieur interne : 004B74 ( Main/Exploration ); précédent : 004B73; suivant : 004B75Risk evaluation in cutaneous melanoma patients undergoing lymph node dissection: impact of POSSUM
Auteurs : F. Egberts ; C. Hartje ; C. Schafmayer ; Kc Kaehler ; W. Von Schönfels ; A. Hauschild ; T. Becker ; Jh EgbertsSource :
- Annals of The Royal College of Surgeons of England [ 0035-8843 ] ; 2011.
Abstract
When lymphatic metastasis occurs, surgery is the primary treatment modality in melanoma patients. Depending on the tumour stage, patients receive a completion lymph node dissection (CLND) when a positive sentinel node is detected. Patients with clinically evident disease of the regional lymph nodes are recommended to undergo a therapeutic lymph node dissection (TLND). The aim of this study was to assess the morbidity of CLND and TLND and to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) for preoperative risk adjustment of postoperative morbidity.
The hospital files of 143 patients who underwent CLND and TLND for malignant melanoma were analysed. The POSSUM score was used to predict morbidity rates after surgery for the total patient group as well as separated for CLND and TLND patients.
The overall complication rate was 28.0% and the mortality rate was 0%. The morbidity rate predicted by POSSUM was 32.9%, the mortality 8.3%. Morbidity in patients undergoing CLND was significantly higher with regard to overall wound complications compared with patients with TLND. In these subgroups, POSSUM failed to predict the rates precisely.
The POSSUM score predicted the morbidity of the total patient group accurately but failed to predict the rates in the TLND and CLND subgroups. Patients receiving CLND showed the highest morbidity rates. Preoperative sentinel lymph node biopsy therefore has more influence on postoperative morbidity than the physiological parameters represented in the POSSUM physiological score.
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DOI: 10.1308/147870811X13137608455019
PubMed: 22004633
PubMed Central: 3604920
Affiliations:
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Hauschild</name></author><author><name sortKey="Becker, T" sort="Becker, T" uniqKey="Becker T" first="T" last="Becker">T. Becker</name></author><author><name sortKey="Egberts, Jh" sort="Egberts, Jh" uniqKey="Egberts J" first="Jh" last="Egberts">Jh Egberts</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22004633</idno><idno type="pmc">3604920</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604920</idno><idno type="RBID">PMC:3604920</idno><idno type="doi">10.1308/147870811X13137608455019</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002C19</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002C19</idno><idno type="wicri:Area/Pmc/Curation">002C18</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002C18</idno><idno type="wicri:Area/Pmc/Checkpoint">002D57</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002D57</idno><idno type="wicri:Area/Ncbi/Merge">004746</idno><idno type="wicri:Area/Ncbi/Curation">004746</idno><idno type="wicri:Area/Ncbi/Checkpoint">004746</idno><idno type="wicri:doubleKey">0035-8843:2011:Egberts F:risk:evaluation:in</idno><idno type="wicri:Area/Main/Merge">004C06</idno><idno type="wicri:Area/Main/Curation">004B74</idno><idno type="wicri:Area/Main/Exploration">004B74</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Risk evaluation in cutaneous melanoma patients undergoing lymph node dissection: impact of POSSUM</title><author><name sortKey="Egberts, F" sort="Egberts, F" uniqKey="Egberts F" first="F" last="Egberts">F. Egberts</name></author><author><name sortKey="Hartje, C" sort="Hartje, C" uniqKey="Hartje C" first="C" last="Hartje">C. Hartje</name></author><author><name sortKey="Schafmayer, C" sort="Schafmayer, C" uniqKey="Schafmayer C" first="C" last="Schafmayer">C. Schafmayer</name></author><author><name sortKey="Kaehler, Kc" sort="Kaehler, Kc" uniqKey="Kaehler K" first="Kc" last="Kaehler">Kc Kaehler</name></author><author><name sortKey="Von Schonfels, W" sort="Von Schonfels, W" uniqKey="Von Schonfels W" first="W" last="Von Schönfels">W. Von Schönfels</name></author><author><name sortKey="Hauschild, A" sort="Hauschild, A" uniqKey="Hauschild A" first="A" last="Hauschild">A. Hauschild</name></author><author><name sortKey="Becker, T" sort="Becker, T" uniqKey="Becker T" first="T" last="Becker">T. Becker</name></author><author><name sortKey="Egberts, Jh" sort="Egberts, Jh" uniqKey="Egberts J" first="Jh" last="Egberts">Jh Egberts</name></author></analytic><series><title level="j">Annals of The Royal College of Surgeons of England</title><idno type="ISSN">0035-8843</idno><idno type="eISSN">1478-7083</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>INTRODUCTION</title><p>When lymphatic metastasis occurs, surgery is the primary treatment modality in melanoma patients. Depending on the tumour stage, patients receive a completion lymph node dissection (CLND) when a positive sentinel node is detected. Patients with clinically evident disease of the regional lymph nodes are recommended to undergo a therapeutic lymph node dissection (TLND). The aim of this study was to assess the morbidity of CLND and TLND and to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) for preoperative risk adjustment of postoperative morbidity.</p></sec><sec><title>METHODS</title><p>The hospital files of 143 patients who underwent CLND and TLND for malignant melanoma were analysed. The POSSUM score was used to predict morbidity rates after surgery for the total patient group as well as separated for CLND and TLND patients.</p></sec><sec><title>RESULTS</title><p>The overall complication rate was 28.0% and the mortality rate was 0%. The morbidity rate predicted by POSSUM was 32.9%, the mortality 8.3%. Morbidity in patients undergoing CLND was significantly higher with regard to overall wound complications compared with patients with TLND. In these subgroups, POSSUM failed to predict the rates precisely.</p></sec><sec><title>CONCLUSIONS</title><p>The POSSUM score predicted the morbidity of the total patient group accurately but failed to predict the rates in the TLND and CLND subgroups. Patients receiving CLND showed the highest morbidity rates. Preoperative sentinel lymph node biopsy therefore has more influence on postoperative morbidity than the physiological parameters represented in the POSSUM physiological score.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Becker, T" sort="Becker, T" uniqKey="Becker T" first="T" last="Becker">T. Becker</name><name sortKey="Egberts, F" sort="Egberts, F" uniqKey="Egberts F" first="F" last="Egberts">F. Egberts</name><name sortKey="Egberts, Jh" sort="Egberts, Jh" uniqKey="Egberts J" first="Jh" last="Egberts">Jh Egberts</name><name sortKey="Hartje, C" sort="Hartje, C" uniqKey="Hartje C" first="C" last="Hartje">C. Hartje</name><name sortKey="Hauschild, A" sort="Hauschild, A" uniqKey="Hauschild A" first="A" last="Hauschild">A. Hauschild</name><name sortKey="Kaehler, Kc" sort="Kaehler, Kc" uniqKey="Kaehler K" first="Kc" last="Kaehler">Kc Kaehler</name><name sortKey="Schafmayer, C" sort="Schafmayer, C" uniqKey="Schafmayer C" first="C" last="Schafmayer">C. Schafmayer</name><name sortKey="Von Schonfels, W" sort="Von Schonfels, W" uniqKey="Von Schonfels W" first="W" last="Von Schönfels">W. Von Schönfels</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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