title: Early (sentinel lymph node biopsy-guided) versus delayed lymphadenectomy in melanoma patients with lymph node metastases : personal experience and literature meta-analysis.
abstract: BACKGROUND
  It is debated whether patients with melanoma who undergo lymphadenectomy after a positive sentinel lymph node (SN) biopsy (SNB) have a better prognosis compared with patients who are treated for clinically evident disease.
  
  
  METHODS
  The records of 190 patients with cutaneous melanoma who underwent radical lymph node dissection after a positive SNB (completion lymph node dissection [CLND]; n = 100) or who had clinically evident lymph node metastasis (therapeutic lymph node dissection [TLND]; n = 90) were analyzed. Moreover, the MEDLINE, EMBASE, and Cochrane databases were searched for studies that investigated the survival impact of SNB-guided CLND compared with TLND for clinically evident disease. Standard meta-analysis methods were used to calculate the overall treatment effect across eligible studies.
  
  
  RESULTS
  In the authors' series, tumor characteristics did not differ significantly between patients who underwent CLND and those who underwent TLND. After a median follow-up of 52.6 months, the 5-year overall survival rate did not differ significantly between CLND patients and TLND patients (68.9% vs 50.4%, respectively; log-rank test; P = .17). In contrast, a meta-analysis of 6 studies (n = 2633) that addressed this issue (including the authors' own series) indicated that there was a significantly higher risk of death for patients who underwent TLND compared with that for patients who underwent CLND (hazard ratio, 1.60; 95% confidence interval, 1.28-2.00; P < .0001).
  
  
  CONCLUSIONS
  Although no significant survival difference was observed in either series, the pooling of summary data from all the studies that dealt with this issue suggested that SNB-guided CLND is associated with a significantly better outcome compared with TLND for clinically evident lymph node disease.
authors.affiliation: Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Pasquali
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Luca G
authors.initials: LG
authors.lastname: Campana
authors.forename: Elena
authors.initials: E
authors.lastname: Bonandini
authors.forename: Maria C
authors.initials: MC
authors.lastname: Montesco
authors.forename: Alberto
authors.initials: A
authors.lastname: Tregnaghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Fiore
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Carlo R
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015201:Meta-Analysis as Topic; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors