title: Reliability and cost-effectiveness of complete lymph node dissection under tumescent local anaesthesia vs. general anaesthesia: a retrospective analysis in patients with malignant melanoma AJCC stage III.
abstract: BACKGROUND
  Complete lymph node dissection (CLND) in melanoma patients with a positive sentinel lymph node (SLN) is currently being debated, as it is a cost-intensive surgical intervention with potentially high morbidity.
  
  
  OBJECTIVE
  This clinical study seeks to clarify the effectiveness, reliability and cost-effectiveness of CLND performed under tumescent local anaesthesia (TLA) compared with procedures under general anaesthesia (GA).
  
  
  METHODS
  We retrospectively analysed the data from 60 patients with primary malignant melanoma American Joint Committee on Cancer stage III who underwent CLND.
  
  
  RESULTS
  Altogether 26 (43.3%) patients underwent CLND under TLA and 34 (56.7%) patients underwent CLND under GA. Fifteen of 43 (34.9%) patients had a complication, such as development of seromas and/or wound infections. The rate of complications was 25.0% (3/12) in the axilla subgroup and 28.6% (4/14) in the groin subgroup of the TLA group. In the GA group, the complication rate was 31.3% (5/16) in the axilla subgroup and 44.4% (8/18) in the groin subgroup. The costs for CLND were significantly less for the CLND in a procedure room performed under TLA (mean €67.26) compared with CLND in an operating room under GA (mean €676.20, P < 0.0001).
  
  
  CONCLUSIONS
  In conclusion, this study confirms that TLA is an excellent, safe, effective and cost-efficient alternative to GA for CLND in melanoma patients.
authors.affiliation: Department of Dermatology, Venerology and Allergology, University of Essen-Duisburg, Essen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Stoffels
authors.forename: J
authors.initials: J
authors.lastname: Dissemond
authors.forename: A
authors.initials: A
authors.lastname: Schulz
authors.forename: U
authors.initials: U
authors.lastname: Hillen
authors.forename: D
authors.initials: D
authors.lastname: Schadendorf
authors.forename: J
authors.initials: J
authors.lastname: Klode
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D055815:Young Adult