Complications following completion lymphadenectomy versus therapeutic lymphadenectomy for melanoma - A systematic review of the literature.

Autor: Moody JA; GKT School of Medical Education, King's College London, Great Maze Pond, London, SE1 9RT, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom., Botham SJ; Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom., Dahill KE; Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom., Wallace DL; Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom., Hardwicke JT; Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, United Kingdom; Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom. Electronic address: j.hardwicke@warwick.ac.uk.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2017 Sep; Vol. 43 (9), pp. 1760-1767. Date of Electronic Publication: 2017 Jul 21.
DOI: 10.1016/j.ejso.2017.07.003
Abstrakt: Purpose: Completion lymph node dissection (CLND) following a positive sentinel lymph node biopsy (SLNB) has been reported to be less morbid than lymphadenectomy for palpable disease (therapeutic lymph node dissection; TLND). The reporting of morbidity data can be heterogeneous, and hence no 'average' surgical complication rates of these procedures has been reported. This review aims to determine complications rates to inform patients undergoing surgery for metastatic melanoma.
Methods: A systematic review of English-language literature from 2000 to 2017, reporting morbidity information about CLND and TLND for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of post-operative complications were constructed using a random effects statistical model.
Results: After application of inclusion and exclusion criteria, 18 articles progressed to the final analysis. In relation to TLND (1627 patients), the overall incidence of surgical complications was 39.3% (95% CI 32.6-46.2); including wound infection/breakdown 25.4% (95% CI: 20.9-30.3); lymphoedema 20.9% (95% CI: 13.8-29.1); and seroma 20.4% (95% CI: 15.9-25.2). For CLND (1929 patients), the overall incidence of surgical complications was 37.2% (95% CI 27.6-47.4); including wound infection/breakdown 21.6% (95% CI: 13.8-30.6); lymphoedema 18% (95% CI: 12.5-24.2); and seroma 17.9% (95% CI: 10.3-27). The complication rate was marginally lower for CLND but not to statistical significance.
Discussion: This study provides information about the incidence of complications after CLND and TLND. It can be used to counsel patients about the procedures and it sets a benchmark against which surgeons can audit their practice.
(Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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