ArticleJournal of surgical oncology2025
Lymph Node Dissection for Melanoma: Contemporary Trends in Postoperative Outcomes and Patient Selection With Reduced Case Volumes in the Post-MSLT2 Era.
Article in Journal of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesSince the publication of the German Cooperative Oncology Group Selective Lymphadenectomy Trial and Multicenter Selective Lymphadenectomy Trial II (MSLT2) trials, the treatment paradigm for node-positive melanoma has shifted from completion lymph node dissection (LND) to nodal ultrasound surveillance. We sought to identify the impact of this practice change on postoperative outcomes in a national cohort.
methodsThe American College of Surgeons National Surgical Quality Improvement Program database was queried for patients diagnosed with truncal/extremity malignant melanoma who underwent axillary/inguinal LND. Patients diagnosed with head/neck melanoma with subsequent cervical LND were also analyzed separately. Trends in case volumes, clinicodemographic patient characteristics, and postoperative outcomes were analyzed using univariate and multivariate analyses.
resultsThere has been a reduction of patients undergoing axillary/inguinal LND in the post-MSLT2 era (24.1% vs. 19.0%, p < 0.01). Furthermore, these patients are older (63 vs. 59 years, p < 0.01) and have worse systemic comorbidities (ASA class 3+ +54% vs. 42%, p <0.01). Despite this, postoperative outcomes remain unchanged. For cervical LND, no significant changes in case volumes or clinicodemographic factors were found. Apart from an increase in superficial skin infections in the post-MSLT2 cohort, postoperative outcomes remain largely unchanged.
conclusionsContinued efforts should be made to optimize patient selection and maintain acceptable postoperative morbidity for LND as it becomes more sparingly utilized in the care of patients with melanoma.
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