Regional control after precision lymph node dissection for clinically evident melanoma metastasis.

Autor: Lynch KT; Department of Surgery, University of Virginia, Charlottesville, Virginia, USA., Hu Y; Department of Surgery, University of Maryland, Baltimore, Maryland, USA., Farrow NE; Department of Surgery, Duke University, Durham, North Carolina, USA., Song Y; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Meneveau MO; Department of Surgery, University of Virginia, Charlottesville, Virginia, USA., Kwak M; Department of Surgery, SUNY Downstate, Brooklyn, New York, USA., Lowe MC; Department of Surgery, Emory University, Atlanta, Georgia, USA., Bartlett EK; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA., Beasley GM; Department of Surgery, Duke University, Durham, North Carolina, USA., Karakousis GC; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Slingluff CL; Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2023 Jan; Vol. 127 (1), pp. 140-147. Date of Electronic Publication: 2022 Sep 17.
DOI: 10.1002/jso.27100
Abstrakt: Introduction: Completion lymph node dissection (CLND) for microscopic lymph node metastases has been replaced by observation; however, CLND is standard for clinically detectable nodal metastases (cLN). CLND has high morbidity, which may be reduced by excision of only the cLN (precision lymph node dissection [PLND]). We hypothesized that same-basin recurrence risk would be low after PLND.
Methods: Retrospective review at four tertiary care hospitals identified patients who underwent PLND. The primary outcome was 3-year cumulative incidence of isolated same-basin recurrence.
Results: Twenty-one patients underwent PLND for cLN without synchronous distant metastases. Reasons for forgoing CLND included patient preference (n = 11), comorbidities (n = 5), imaging indeterminate for distant metastases (n = 2), partial response to checkpoint blockade (n = 1), or not reported (n = 2). A median of 2 nodes (range: 1-6) were resected at PLND, and 68% contained melanoma. Recurrence was observed in 33% overall. Only 1 patient (5%) developed an isolated same-basin recurrence. Cumulative incidences at 3 years were 5.0%, 17.3%, and 49.7% for isolated same-basin recurrence, any same-basin recurrence, and any recurrence, respectively. Complications from PLND were reported in 1 patient (5%).
Conclusions: These pilot data suggest that PLND may provide adequate regional disease control with less morbidity than CLND. These data justify prospective evaluation of PLND in select patients.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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