scholarly journals Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 117
Author(s):  
Eleonora Nacchiero ◽  
Michele Maruccia ◽  
Fabio Robusto ◽  
Rossella Elia ◽  
Alessio Di Cosmo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Control Group ◽  
Node Dissection ◽  
Secondary Lymphedema ◽  
Lymphatic Metastases ◽  
Melanoma Patients ◽  
Group 2 ◽  
Complete Lymph Node Dissection ◽  
Group 1

Background and Objectives: Current guidelines have limited the performance of complete lymph node dissection (CLND) for patients with clinically detectable lymphatic metastases. Despite the limitations of this surgical procedure, secondary lymphedema (SL) is an unsolved problem that affects approximately 20% of patients undergoing CLND. Preventive lymphatic–venous micro-anastomoses (PMLVA) has already demonstrated its efficacy in the prevention of SL in melanoma patients with a positive sentinel lymph node biopsy (SLNB), but the efficacy of this procedure is not demonstrated in patients with clinically detectable lymphatic metastases. Materials and Methods: This retrospective cohort study, was performed in two observation periods. Until March 2018, CLND was proposed to all subjects with positive-SLNB andPMLVA was performed in a subgroup of patients with risk factors for SL (Group 1). From April 2018, according to the modification of melanoma guidelines, all patients with detectable metastatic lymph nodes underwent PMLVA during CLND (Group 2). The frequency of lymphedema in subjects undergoing PMLVA was compared with the control group. Results: Database evaluation revealed 172 patients with melanoma of the trunk with follow-up information for at least 6 mounts. Twenty-three patients underwent PMLVA during CLND until March 2018, 29 from April 2018, and 120 subjects underwent CLND without any preventive surgery (control Group). The frequency of SL was significantly lower in both Group 1 (4.3% vs. 24.2%, p = 0.03) and Group 2 (3.5%, p = 0.01). Patients undergoing PMLVA showed a similar recurrence-free periods and overall survival when compared to the control group. Conclusions: PMLVA significantly reduces the frequency of SL both in immediate and delayed CLND. This procedure is safe and does not lead to an increase in length of hospitalization.

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

2015 ◽  
Vol 33 (18_suppl) ◽  
pp. LBA9002-LBA9002 ◽  
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.

Low incidence of nonsentinel node-positivity after complete lymph node dissection in melanoma patients with positive sentinel nodes

2007 ◽  
Vol 12 (3) ◽  
pp. 242-243
Author(s):  
Arata Tsutsumida ◽  
Hiroshi Furukawa ◽  
Yuhei Yamamoto ◽  
Katsumi Horiuchi ◽  
Tetsunori Yoshida ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Sentinel Nodes ◽  
Melanoma Patients ◽  
Low Incidence ◽  
Nonsentinel Node ◽  
Complete Lymph Node Dissection

Is there a therapeutic benefit of complete lymph node dissection in melanoma patients with low tumor burden in the sentinel node?

2014 ◽  
Vol 24 (5) ◽  
pp. 454-461 ◽  
Author(s):  
Imke Satzger ◽  
Andre Meier ◽  
Antonia Zapf ◽  
Margarete Niebuhr ◽  
Alexander Kapp ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Lymph Node Dissection ◽  
Therapeutic Benefit ◽  
Tumor Burden ◽  
Node Dissection ◽  
Melanoma Patients ◽  
Complete Lymph Node Dissection

scholarly journals Non-Sentinel Lymph Node Detection during Sentinel Lymph Node Biopsy in Not-Complete-Lymph-Node-Dissection Era: A New Technique for Better Staging and Treating Melanoma Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4319
Author(s):  
Franco Picciotto ◽  
Gianluca Avallone ◽  
Federico Castellengo ◽  
Martina Merli ◽  
Virginia Caliendo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Lymph Node Biopsy ◽  
Node Dissection ◽  
Node Biopsy ◽  
Melanoma Patients ◽  
Complete Lymph Node Dissection

Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography—computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically “excluded” lymph nodes, guiding the surgeon’s hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a “classic” setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.

scholarly journals Ultrasound diagnosis of cervical lymph node metastases in patients with first diagnosed papillary thyroid cancer and in patients previously treated surgically and admitted for radioactive iodine therapy

2020 ◽  
Vol 7 (2) ◽  
pp. 47-55
Author(s):  
V. S. Parshin ◽  
A. D. Kaprin ◽  
S. A. Ivanov ◽  
A. A. Veselova ◽  
P. I. Garbuzov ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Cervical Lymph Node ◽  
Radioactive Iodine ◽  
Radioactive Iodine Therapy ◽  
Node Dissection ◽  
National Medical ◽  
Cervical Lymph Node Dissection ◽  
Group 2 ◽  
Group 1

Purpose of the study. To evaluate the potentialities of ultrasound method in diagnosing cervical lymph node metastasis in patients with first diagnosed papillary thyroid cancer (group 1) and in patients previously treated surgically at different clinics of the Russian Federation and subsequently admitted to the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center to receive radioactive iodine therapy (group 2).Patients and methods. Patients with PTC were divided into two groups. Group 1 included 649 patients with first diagnosed PTC. All the patients underwent thyroidectomy and level VI lymph node neck dissection at the clinic of the A.F.Tsyb Medical Radiological Research Center — Branch of the National Medical Research Radiological Center. Of these patients, 92 patients underwent cervical lymph node dissection including levelsII–III–IV and 9 patients underwent cervical lymph node dissection including level VB. Group 2 consisted of 2875 patients who had previously received surgery at different clinics of the Russian Federation. Subsequently, they were admitted to our institution to receive radioactive iodine therapy. In 291 of these patients, cervical lymph node metastases were found and reoperations were performed: in 89 cases at level VI, in 170 cases at levels II–III–IV and in 32 cases at level VB. The detected metastases were verified histologically.Results. Histology confirmed the presence of nodal metastasis in 57.6% of 649 patients in group 1, and in 10.1% of 241 patients in group 2. In group 1, the incidence of metastatic disease in level VI nodes was 73% and in group 2, it was 30.6%. Metastases in levels II–III–IV were noted in 24.6% of patients in group 1, and in 58.4% of patients in group 2. Level VB metastasis was found in 2.4% of patients in group 1, and in 11% of patients in group 2. Multiple metastases were detected in 75.4% of patients in group 1, and in 20.3% of patients in group 2.Conclusion. Central lymph node metastasis was observed in 73% of patients who were first diagnosed with PTC and treated with thyroidectomy and prophylactic level VI cervical lymph node dissection. In group 2, solitary metastases to lateral lymph nodes occurred more frequently after surgical treatment for PTC, which suggested that the primary treatment was insufficiently radical.

Results of complete lymph node dissection in 83 melanoma patients with positive sentinel nodes

1998 ◽  
Vol 5 (2) ◽  
pp. 119-125 ◽  
Author(s):  
Emmanuella Joseph ◽  
Andrea Brobeil ◽  
Frank Glass ◽  
Jillian Glass ◽  
Jane Messina ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Sentinel Nodes ◽  
Melanoma Patients ◽  
Complete Lymph Node Dissection
Sign in / Sign up

Export Citation Format

Share Document