Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma.
BACKGROUND
This study assessed and compared the morbidity of nodal dissection in the axilla and groin including sentinel lymph node biopsy (SLNB), completion lymph node dissection for a positive SLNB (CLND) and therapeutic lymph node dissection (TLND) with and without adjuvant radiotherapy (RT).


METHODS
Patients who had nodal dissection in the axilla or groin for cutaneous melanoma over an 18-year period (1995-2013) were prospectively documented on a database. The median follow-up was nearly 3 years. Early complications and clinically relevant lymphoedema were retrospectively analysed to assess the incidence and differences between the region and type of nodal surgery.


RESULTS
Included were 1521 patients following nodal dissection in the axilla (916 patients) and groin (605 patients). Less early complications occurred following SLNB in the axilla compared with the groin (5% versus 14%, P = 0.0001). Early complications were similar for CLND and TLND in the groin (49% versus 43%, P = 0.879) and axilla (28% versus 33%, P = 0.607). Moderate to severe lymphoedema rates were similar following axillary SLNB and CLND (6% versus 8%, P = 0.407). The lymphoedema rate for groin SLNB was lower than CLND (10% versus 20%, P = 0.063). No significant difference in lymphoedema rates followed CLND and TLND in each region. Following TLND, RT increased lymphoedema rates.


CONCLUSIONS
Morbidity may occur following SLNB with the groin having a higher rate of early complications and lymphoedema compared with the axilla. The morbidity following CLND and TLND were similar. Lymphoedema rates were increased following RT.
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The University of Queensland, Mater Health Services, Brisbane, Queensland, Australia.
Jane E
JE
Theodore
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Adam J
AJ
Frankel
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia.
Janine M
JM
Thomas
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.
Andrew P
AP
Barbour
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Gerard J
GJ
Bayley
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The University of Queensland, Mater Health Services, Brisbane, Queensland, Australia.
Christopher P
CP
Allan
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.
Michael
M
Wagels
The Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.|Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia.
B Mark
BM
Smithers
D000328:Adult; D000368:Aged; D001365:Axilla; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging / Q000379:methods*; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma
general surgery; plastic and reconstructive surgery; surgical oncology