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Use of Completion Lymph Node Dissection for Sentinel Lymph Node-Positive Melanoma
- Source :
- Journal of the American College of Surgeons. 230(4)
- Publication Year :
- 2019
-
Abstract
- For patients with sentinel node-positive melanoma (SNPM), randomized trials, first reported in 2015, found no benefit for routine completion lymph node dissection (CLND) in selected patients. This study examines time trends in CLND and explores institutional and clinical factors associated with CLND.The National Cancer Database was queried for patients older than 18 years from 2012 to 2016 with SNPM. A high-volume center was defined as80th percentile for number of sentinel node procedures. Poisson regression assessed temporal trends and identified patient, pathologic, and institutional characteristics associated with CLND.From 2012 to 2016, we identified 7,146 patients with SNPM. The proportion of patients undergoing CLND was steady in 2012 to 2014 (61% to 63%), but decreased to 57% in 2015 and 50% in 2016 (p0.0001). The proportion of patients with SNPM who underwent CLND decreased over time for both high- (66% to 52%; p0.0001) and lower-volume centers (55% to 45%; p = 0.06). Female sex (relative risk [RR] 0.97; p0.001) and increasing age (RR 0.98; p0.0001) were associated with lower likelihood of CLND. Increased Breslow depth (RR 1.015; p = 0.006), ulceration (RR 1.067; p = 0.02), and high-volume centers (RR 1.180; p0.0001) were associated with higher likelihood of CLND. Regional differences in likelihood of CLND were also present (p0.0001).Completion lymph node dissection in SNPM decreased over time, with the greatest change in 2016. Several patient, pathologic, and institutional characteristics were associated with likelihood of CLND. As evidence supports close observation for selected patients, efforts should be undertaken to improve and standardize patient selection for CLND across institutions caring for patients with melanoma.
- Subjects :
- Adult
Male
medicine.medical_specialty
Skin Neoplasms
Time Factors
Sentinel lymph node
030230 surgery
law.invention
03 medical and health sciences
symbols.namesake
0302 clinical medicine
Randomized controlled trial
law
medicine
Humans
Poisson regression
Lymph node
Melanoma
Aged
business.industry
Cancer
Sentinel node
Middle Aged
medicine.disease
Dissection
medicine.anatomical_structure
030220 oncology & carcinogenesis
symbols
Lymph Node Excision
Surgery
Female
Radiology
Sentinel Lymph Node
business
Subjects
Details
- ISSN :
- 18791190
- Volume :
- 230
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi.dedup.....67aeaf7843fbb77c9034c123ddd92cbc