SO05�MORBIDITY OF REGIONAL LYMPH NODE SURGERY FOR CUTANEOUS MELANOMA

Purpose: Sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) following a positive SLNB have been proposed as less morbid alternatives to therapeutic lymph node dissection (TLND) for macroscopic lymphadenopathy. This study compares the morbidity of SLNB, CLND, and TLND performed in the axilla or groin. Methodology: Seven hundred and twenty patients (449 axilla, 271 groin) who underwent regional lymph node surgery from 1996 to 2008 were identified from a prospectively maintained database. Complications were analysed according to type, site, procedure and administration of adjuvant radiotherapy by Chi square and Fisher's exact tests. Results: Of the 720 patients, 421 (58%) patients underwent SLNB alone, 69 (10%) CLND, and 230 (32%) TLND. Following SLNB, 38/421 (9%) patients developed lymphoedema and this was significantly less than the rate following CLND (38/69 [55%] patients, p < 0.01) and TLND (129/230 [56%] patients, p < 0.01). Among SLNB patients, procedures in the groin (25/150 [17%] patients) were significantly more likely to develop lymphoedema than axilla (13/271 [5%] patients, p < 0.01). There was no significant difference between the incidence of lymphoedema following CLND and TLND. Lymphoedema was significantly more common after CLND or TLND in the groin (92/121 [76%] patients) compared with the axilla (76/178 [43%] patients, p < 0.01). Adjuvant radiotherapy was not associated with a significant increase in lymphoedema. Conclusion: SLNB is a low morbidity procedure. In contrast, both CLND and TLND carry similar high rates of lymphoedema, particularly in the groin. These data should be taken into consideration when counselling patients with positive SLNB.