Lymphadenectomy after melanoma - A national analysis of recurrence rates and risk of lymphedema
Chen Shen*1, Priscila Cevallos1, Jennifer K. Shah2, Rahim Nazerali2, Joseph Rosen1
1Plastic Surgery, Dartmouth-Hitchcock Medical Center, West Lebanon, NH; 2Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA
Treatment for melanoma following a positive sentinel lymph node biopsy (SLNB) includes nodal observation or completion lymph node dissection (CLND). Important management considerations involve balancing risk of recurrence and risk of lymphedema following CLND.
From the IBM® MarketScan® Research Databases, adult patients were queried from January 2007 to December 2021. International Classification of Disease, ninth (ICD-9) and tenth (ICD-10) edition, diagnosis codes and Current Procedural Terminology (CPT) codes were used to identify patients with melanoma diagnoses who underwent melanoma excision with a positive SLNB. From this study cohort, melanoma recurrence (defined as re-excision at least two years following the index excision) and lymphedema rates were compared between patients who underwent CLND and those who did not. Demographics and comorbidities (measured by the Elixhauser index) were recorded. Chi-squared, Schapiro-Wilk, Wilcoxon-Mann-Whitney, and multivariable logistic regression tests were used for statistical analysis.
A total of 153,085,453 patients were identified. The study cohort comprised 2777 patients who underwent melaoma excision with a positive SLNB. Mean age was 49 years, 57% were male, 42% were geographically located in the South, and 31% had an Elixhauser Index of 4+. A total of 1332 (48%) patients did not undergo CLND, of which 5% experienced recurrence and 25% experienced lymphedema. A total of 1445 (52%) patients underwent CLND, of which 4% experienced recurrence and 25% experienced lymphedema. CLND affected neither recurrence rate (OR 1.12, p=0.30) nor lymphedema rate (OR 0.92, p=0.36). When expanded to all patients who underwent SLNB, the rate of lymphedema was 18% in patients who underwent CLND and 5% in those who did not (OR 3.94, p<0.001). Among patients who underwent CLND, timing to CLND had no significant impact on odds of recurrence (OR 1.00, p=0.08).
CLND does not decrease odds of recurrence. CLND neither increases the odds of lymphedema nor possesses a time-dependent effect on recurrence rates in patients with a positive SLNB.
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