The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I)
Identifieur interne : 005565 ( Main/Exploration ); précédent : 005564; suivant : 005566The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I)
Auteurs : Mark B. Faries ; John F. Thompson ; Alistair Cochran ; Robert Elashoff ; Edwin C. Glass ; Nicola Mozzillo ; Omgo E. Nieweg ; Daniel F. Roses ; Harold J. Hoekstra ; Constantine P. Karakousis ; Douglas S. Reintgen ; Brendon J. Coventry ; He-Jing Wang ; Donald L. MortonSource :
- Annals of surgical oncology [ 1068-9265 ] ; 2010.
Descripteurs français
- KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Biopsie de noeud lymphatique sentinelle, Durée du séjour, Femelle, Humains, Jeune adulte, Lymphadénectomie, Morbidité, Mâle, Mélanome (), Mélanome (anatomopathologie), Métastase lymphatique, Pronostic, Sujet âgé, Taux de survie, Tumeurs cutanées (), Tumeurs cutanées (anatomopathologie), Études de suivi.
- MESH :
- anatomopathologie : Mélanome, Tumeurs cutanées.
- Adolescent, Adulte, Adulte d'âge moyen, Biopsie de noeud lymphatique sentinelle, Durée du séjour, Femelle, Humains, Jeune adulte, Lymphadénectomie, Morbidité, Mâle, Mélanome, Métastase lymphatique, Pronostic, Sujet âgé, Taux de survie, Tumeurs cutanées, Études de suivi.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Length of Stay, Lymph Node Excision, Lymphatic Metastasis, Male, Melanoma (pathology), Melanoma (surgery), Middle Aged, Morbidity, Prognosis, Sentinel Lymph Node Biopsy, Skin Neoplasms (pathology), Skin Neoplasms (surgery), Survival Rate, Young Adult.
- MESH :
- pathology : Melanoma, Skin Neoplasms.
- surgery : Melanoma, Skin Neoplasms.
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Length of Stay, Lymph Node Excision, Lymphatic Metastasis, Male, Middle Aged, Morbidity, Prognosis, Sentinel Lymph Node Biopsy, Survival Rate, Young Adult.
Abstract
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 pre-operative 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.
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.
Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have undergone delayed CLND. The two groups were similar for primary tumor features, body mass index, basin location and demographics except age, which was 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=0.04). Length of inpatient hospitalization was also longer for delayed CLND.
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.
Url:
DOI: 10.1245/s10434-010-1203-0
PubMed: 20614193
PubMed Central: 2970739
Affiliations:
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Faries</name></author><author><name sortKey="Thompson, John F" sort="Thompson, John F" uniqKey="Thompson J" first="John F." last="Thompson">John F. Thompson</name></author><author><name sortKey="Cochran, Alistair" sort="Cochran, Alistair" uniqKey="Cochran A" first="Alistair" last="Cochran">Alistair Cochran</name></author><author><name sortKey="Elashoff, Robert" sort="Elashoff, Robert" uniqKey="Elashoff R" first="Robert" last="Elashoff">Robert Elashoff</name></author><author><name sortKey="Glass, Edwin C" sort="Glass, Edwin C" uniqKey="Glass E" first="Edwin C." last="Glass">Edwin C. Glass</name></author><author><name sortKey="Mozzillo, Nicola" sort="Mozzillo, Nicola" uniqKey="Mozzillo N" first="Nicola" last="Mozzillo">Nicola Mozzillo</name></author><author><name sortKey="Nieweg, Omgo E" sort="Nieweg, Omgo E" uniqKey="Nieweg O" first="Omgo E." last="Nieweg">Omgo E. Nieweg</name></author><author><name sortKey="Roses, Daniel F" sort="Roses, Daniel F" uniqKey="Roses D" first="Daniel F." last="Roses">Daniel F. Roses</name></author><author><name sortKey="Hoekstra, Harold J" sort="Hoekstra, Harold J" uniqKey="Hoekstra H" first="Harold J." last="Hoekstra">Harold J. Hoekstra</name></author><author><name sortKey="Karakousis, Constantine P" sort="Karakousis, Constantine P" uniqKey="Karakousis C" first="Constantine P." last="Karakousis">Constantine P. Karakousis</name></author><author><name sortKey="Reintgen, Douglas S" sort="Reintgen, Douglas S" uniqKey="Reintgen D" first="Douglas S." last="Reintgen">Douglas S. Reintgen</name></author><author><name sortKey="Coventry, Brendon J" sort="Coventry, Brendon J" uniqKey="Coventry B" first="Brendon J." last="Coventry">Brendon J. Coventry</name></author><author><name sortKey="Wang, He Jing" sort="Wang, He Jing" uniqKey="Wang H" first="He-Jing" last="Wang">He-Jing Wang</name></author><author><name sortKey="Morton, Donald L" sort="Morton, Donald L" uniqKey="Morton D" first="Donald L." last="Morton">Donald L. Morton</name></author></analytic><series><title level="j">Annals of surgical oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Length of Stay</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Male</term><term>Melanoma (pathology)</term><term>Melanoma (surgery)</term><term>Middle Aged</term><term>Morbidity</term><term>Prognosis</term><term>Sentinel Lymph Node Biopsy</term><term>Skin Neoplasms (pathology)</term><term>Skin Neoplasms (surgery)</term><term>Survival Rate</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Durée du séjour</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Lymphadénectomie</term><term>Morbidité</term><term>Mâle</term><term>Mélanome ()</term><term>Mélanome (anatomopathologie)</term><term>Métastase lymphatique</term><term>Pronostic</term><term>Sujet âgé</term><term>Taux de survie</term><term>Tumeurs cutanées ()</term><term>Tumeurs cutanées (anatomopathologie)</term><term>Études de suivi</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Mélanome</term><term>Tumeurs cutanées</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Melanoma</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Melanoma</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Length of Stay</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Male</term><term>Middle Aged</term><term>Morbidity</term><term>Prognosis</term><term>Sentinel Lymph Node Biopsy</term><term>Survival Rate</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Durée du séjour</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Lymphadénectomie</term><term>Morbidité</term><term>Mâle</term><term>Mélanome</term><term>Métastase lymphatique</term><term>Pronostic</term><term>Sujet âgé</term><term>Taux de survie</term><term>Tumeurs cutanées</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">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 pre-operative 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.</p></sec><sec sec-type="methods" id="S2"><title>Methods</title><p id="P2">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.</p></sec><sec id="S3"><title>Results</title><p id="P3">Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have undergone delayed CLND. The two groups were similar for primary tumor features, body mass index, basin location and demographics except age, which was 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=0.04). Length of inpatient hospitalization was also longer for delayed CLND.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">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.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Cochran, Alistair" sort="Cochran, Alistair" uniqKey="Cochran A" first="Alistair" last="Cochran">Alistair Cochran</name><name sortKey="Coventry, Brendon J" sort="Coventry, Brendon J" uniqKey="Coventry B" first="Brendon J." last="Coventry">Brendon J. Coventry</name><name sortKey="Elashoff, Robert" sort="Elashoff, Robert" uniqKey="Elashoff R" first="Robert" last="Elashoff">Robert Elashoff</name><name sortKey="Faries, Mark B" sort="Faries, Mark B" uniqKey="Faries M" first="Mark B." last="Faries">Mark B. Faries</name><name sortKey="Glass, Edwin C" sort="Glass, Edwin C" uniqKey="Glass E" first="Edwin C." last="Glass">Edwin C. Glass</name><name sortKey="Hoekstra, Harold J" sort="Hoekstra, Harold J" uniqKey="Hoekstra H" first="Harold J." last="Hoekstra">Harold J. Hoekstra</name><name sortKey="Karakousis, Constantine P" sort="Karakousis, Constantine P" uniqKey="Karakousis C" first="Constantine P." last="Karakousis">Constantine P. Karakousis</name><name sortKey="Morton, Donald L" sort="Morton, Donald L" uniqKey="Morton D" first="Donald L." last="Morton">Donald L. Morton</name><name sortKey="Mozzillo, Nicola" sort="Mozzillo, Nicola" uniqKey="Mozzillo N" first="Nicola" last="Mozzillo">Nicola Mozzillo</name><name sortKey="Nieweg, Omgo E" sort="Nieweg, Omgo E" uniqKey="Nieweg O" first="Omgo E." last="Nieweg">Omgo E. Nieweg</name><name sortKey="Reintgen, Douglas S" sort="Reintgen, Douglas S" uniqKey="Reintgen D" first="Douglas S." last="Reintgen">Douglas S. Reintgen</name><name sortKey="Roses, Daniel F" sort="Roses, Daniel F" uniqKey="Roses D" first="Daniel F." last="Roses">Daniel F. Roses</name><name sortKey="Thompson, John F" sort="Thompson, John F" uniqKey="Thompson J" first="John F." last="Thompson">John F. Thompson</name><name sortKey="Wang, He Jing" sort="Wang, He Jing" uniqKey="Wang H" first="He-Jing" last="Wang">He-Jing Wang</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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