Risk factors associated with lymphedema after lymph node dissection in melanoma patients

8514 Background: The benefits of deep pelvic lymph node dissection (DLND) for node-positive melanoma patients continue to be debated. The objective of our analysis was to assess factors associated with metastatic disease to deep pelvic nodes and examine survival outcomes following DLND. Methods: We retrospectively reviewed the records of 804 patients undergoing lymph node dissection (1990-2001). 97 patients underwent a superficial inguinofemoral lymph node dissection along with a DLND for indications which included: suspicious radiologic imaging (n= 31), documented superficial disease and concern for deep involvement (n = 57), and in-transit disease undergoing limb perfusion (n=9). Logistic regression was performed to identify factors associated with the metastatic tumor spread to deep nodes. Associations between clinicopathologic factors and disease-specific survival (DSS) were estimated using the Cox proportional hazards model. Results: Fifty-four patients (56%) had metastatic disease (median 2 positive lymph nodes, range 1–12) within their deep pelvis. With a median follow-up of 7.5 years, the 5-year DSS was 42% for patients with positive deep pelvic nodes and 52% for those with negative deep pelvic nodes (p = 0.07). When the number of metastatic deep nodes was stratified, the 5-year DSS for patients with 1 positive node, 2–3 positive nodes, and >3 positive nodes was 49%, 48%, and 27%, respectively (p = 0.04). Age ≥ 50 years (odds ratio [OR] = 3.5, p = 0.03), increasing number of positive superficial nodes (OR = 2.1, p < 0.001), and suspicious findings on pelvic CT images (OR = 11.9, p < 0.001) were associated with metastatic deep nodes. In the multivariate analysis, the number of positive deep nodes (hazard ratio [HR] = 1.1, p = 0.03), male gender (HR = 1.9, p = 0.03), and extra-capsular nodal extension of tumor (HR = 2.7, p < 0.001) were identified as adverse prognostic factors for DSS. Conclusions: Survival outcomes in patients with melanoma metastatic to ≤ 3 deep pelvic lymph nodes are comparable to those in patients without deep nodal involvement. These favorable outcomes support an aggressive surgical approach (i.e., DLND) in patients ≥ 50 years, with multiple positive superficial nodes, and suspicious CT findings. No significant financial relationships to disclose.

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FC11 Does systemic treatment prior to completion lymph node dissection influence surgical outcomes in stage III melanoma patients?

Melanoma Research ◽

10.1097/01.cmr.0000382813.52699.b3 ◽

2010 ◽

Vol 20 ◽

pp. e33-e34

Author(s):

N. Kounalakis ◽

R. Gonzalez ◽

M.A. Becker ◽

K.D. Lewis ◽

A. Christenson ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Surgical Outcomes ◽

Systemic Treatment ◽

Stage Iii ◽

Completion Lymph Node Dissection ◽

Node Dissection ◽

Melanoma Patients ◽

Stage Iii Melanoma

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Early Diagnosis and Risk Factors for Lymphedema following Lymph Node Dissection for Gynecologic Cancer

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e318277870f ◽

2013 ◽

Vol 131 (2) ◽

pp. 283-290 ◽

Cited By ~ 47

Author(s):

Shinsuke Akita ◽

Nobuyuki Mitsukawa ◽

Naoaki Rikihisa ◽

Yoshitaka Kubota ◽

Naoko Omori ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Early Diagnosis ◽

Lymph Node Dissection ◽

Gynecologic Cancer ◽

Node Dissection

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Risk factors of developing lymphogenic complications after radical prostatectomy with pelvic lymph node dissection

Urologiia ◽

10.18565/urology.2021.3.114-121 ◽

2021 ◽

Vol 3_2021 ◽

pp. 114-121

Author(s):

S.V. Kotov Kotov ◽

А.О. Prostomolotov Prostomolotov ◽

A.A. Nemenov Nemenov ◽

◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Node Dissection ◽

Pelvic Lymph Node Dissection ◽

Pelvic Lymph Node ◽

Node Dissection

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Isolated same-basin lymph node recurrence after precision lymph node excision for clinically evident melanoma metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.9576 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 9576-9576

Author(s):

Kevin Lynch ◽

Yinin Hu ◽

Norma Farrow ◽

Yun Song ◽

Max Meneveau ◽

...

Keyword(s):

Lymph Node ◽

Disease Control ◽

Lymph Node Dissection ◽

Patient Preference ◽

Distant Metastases ◽

Node Dissection ◽

Melanoma Patients ◽

Regional Disease ◽

In Transit

9576 Background: While management of the nodal basin for melanoma has largely moved to observation for microscopic sentinel lymph node (SLN) metastasis, complete lymph node dissection (CLND) remains the current standard of care for melanoma patients with macroscopic, clinically detectable lymph node metastases (cLN). As CLND is associated with high surgical morbidity, we sought to study whether cLN may be safely managed by excision of only clinically abnormal nodes (precision lymph node dissection, PLND). Currently, a small subset of patients with cLN do not undergo CLND because of frailty or patient preference. We hypothesized that in these selected patients, PLND would provide acceptable regional control rates. Methods: Retrospective chart review was conducted at four academic tertiary care hospitals to identify melanoma patients who underwent PLND for cLN. cLN were defined as palpable or radiographically abnormal nodes. Recurrences were categorized as local/in-transit, same-basin lymph node, or distal lymph node/visceral. The primary outcome was isolated same-basin recurrence after PLND. Results: Twenty-one patients underwent PLND for cLN without synchronous distant metastases (characteristics of primary lesions summarized in Table). Reasons for forgoing CLND included patient preference (n=8), imaging indeterminate for distant metastases (n=2), comorbidities (n=4), loss to follow up (n=1), partial response to checkpoint blockade (n=1), or not reported (n=5). The inguinal node basin was the most common site (n=10), followed by the axillary (n=8) and cervical basins (n=3). A median of 2 nodes were resected at PLND, and 68% of resected nodes were positive for melanoma (median: 1, range: 1-3 nodes). Median follow-up was 23 months from PLND, and recurrence was observed in 28.6% of patients overall. Only 1 patient (4.8%) developed an isolated same-basin recurrence. The 3-year cumulative incidence of isolated same-basin recurrence was 5.3%, while risk of isolated local/in-transit recurrence or distant basin/visceral metastasis were 19.8% and 33.3%, respectively. Complications from PLND were reported in 1 patient (4.8%) and were limited to post-operative seroma and lymphedema. Conclusions: These pilot data suggest that PLND may offer acceptable regional disease control for cLN. Post-operative morbidity from PLND was also low, raising the possibility that PLND may provide adequate regional disease control without the morbidity associated with CLND. These data justify additional, prospective evaluation of PLND in selected patients.[Table: see text]

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Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection

Breast Cancer ◽

10.1007/s12282-019-01020-y ◽

2019 ◽

Vol 27 (2) ◽

pp. 284-290 ◽

Cited By ~ 1

Author(s):

Yoshiteru Akezaki ◽

Eiji Nakata ◽

Masato Kikuuchi ◽

Ritsuko Tominaga ◽

Hideaki Kurokawa ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Lymph Node ◽

Cancer Patients ◽

Axillary Lymph Node Dissection ◽

Lymph Node Dissection ◽

Axillary Lymph Node ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Node Dissection

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Accuracy of clinical nodal staging and factors associated with receipt of lymph node dissection at the time of surgery for nonmetastatic renal cell carcinoma

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2019.06.003 ◽

2019 ◽

Vol 37 (9) ◽

pp. 577.e17-577.e25 ◽

Cited By ~ 1

Author(s):

Kushan D. Radadia ◽

Zorimar Rivera-Núñez ◽

Sinae Kim ◽

Nicholas J. Farber ◽

Joshua Sterling ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Lymph Node Dissection ◽

Renal Cell ◽

Nodal Staging ◽

Node Dissection ◽

Factors Associated ◽

Time Of Surgery

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RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.07 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 41-41

Author(s):

Xiaofeng Duan ◽

Zhentao Yu

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Location ◽

Individual Risk ◽

Node Dissection ◽

Early Esophageal Cancer ◽

Node Metastasis ◽

The Individual

Abstract Background Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation. Methods We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis. Results In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%. Conclusion T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy. Disclosure All authors have declared no conflicts of interest.

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Survival of SLNB-positive melanoma patients with and without complete lymph node dissection: A multicenter, randomized DECOG trial.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.18_suppl.lba9002 ◽

2015 ◽

Vol 33 (18_suppl) ◽

pp. LBA9002-LBA9002 ◽

Cited By ~ 9

Author(s):

Ulrike Leiter ◽

Rudolf Stadler ◽

Cornelia Mauch ◽

Werner Hohenberger ◽

Norbert Brockmeyer ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Distant Metastases ◽

Tumor Burden ◽

Phase Iii ◽

Node Dissection ◽

Significant Treatment ◽

Melanoma Patients ◽

Complete Lymph Node Dissection

LBA9002 Background: Complete lymph node dissection (CLND) following positive sentinel node biopsy (SLNB) was evaluated in a randomized phase III trial. Methods: 1,258 patients with cutaneous melanoma of the trunk and extremities and with positive SLNB were evaluated. Of these, 483 (39%) agreed to randomization into the clinical trial. 241 patients underwent observation only, 242 received CLND. Both groups had a subsequent 3-years follow-up. Recurrence-free (RFS), distant metastases free (DMFS) and melanoma specific (MSS) survival were analyzed as endpoints. Results: Patient enrolment was performedfrom January 2006 to December 2014. In the intent to treat analysis, both groups did not differ significantly in distribution of age, gender, localization, ulceration, tumor thickness (median 2,4 mm in both groups), number of positive nodes, or tumor burden in the SN. The mean follow-up time was 34 months (SD ± 22.1). No significant treatment-related difference was seen in the 5-years RFS (P = 0.72), DMFS (P= 0 .76) and MSS (P = 0.86) in the overall study population. Conclusions: In this early analysis of trial results, no survival benefit was achieved by CLND in melanoma patients with positive SLNB. A subsequent analysis three years after inclusion of the last patient is planned.

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