Elective lymph node dissection in patients with melanoma: systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
Elective lymph node dissection does not improve survival in patients with melanoma without clinically detectable lymph node metastases.


OBJECTIVE
To determine whether elective lymph node dissection in patients with melanoma without clinically detectable regional metastases decreases overall mortality.


METHODS
Systematic review and meta-analysis of randomized controlled trials comparing elective lymph node dissection with delayed lymphadenectomy at the time of clinical recurrence.


METHODS
Randomized controlled trials available by February 2001.


METHODS
The included trials comprised 1533 participants.


METHODS
Elective lymph node dissection compared with delayed lymphadenectomy or no lymphadenectomy in patients with melanoma without clinically detectable regional metastases.


METHODS
Overall mortality in treatment groups as compared with control groups at the end of a 5-year follow-up period.


RESULTS
Three randomized controlled trials met the inclusion criteria. The pooled odds ratio for overall mortality for the 3 trials was 0.86 (95% confidence interval, 0.68-1.09). Results are statistically nonsignificant, but they have potential clinical significance.


CONCLUSIONS
This systematic review of randomized controlled trials comparing elective lymph node dissection with surgery delayed until the time of clinical recurrence shows no significant overall survival benefit for patients undergoing elective lymph node dissection. Trials included in this review, however, contain significant bias. The question is not answered for all patients, and the results do not exclude the possibility that some subgroups may benefit from elective lymph node dissection. Further research is required.
Lens
Marko B
MB
Centre for Evidence-Based Medicine, University of Oxford Nuffield Department of Clinical Medicine, the Oxford Radcliffe National Health Service Trust, Oxford OX3 9DU, England. markolens@aol.com
Dawes
Martin
M
Goodacre
Tim
T
Newton-Bishop
Julia A
JA
D017558:Elective Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate