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Morbidity and Outcomes Following Axillary Lymphadenectomy for Melanoma: Weighing the Risk of Surgery in the Era of MSLT-II

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Limited data exist characterizing complications after axillary lymphadenectomy for melanoma. With high rates of complications reported after dissection for breast cancer and data suggesting that completion lymphadenectomy may have limited therapeutic benefit, this study characterized morbidity to facilitate clinical decision-making.

Methods

Using a broad definition for complications, patients who underwent axillary dissection for melanoma at a single center (from 2003 to 2015) were assessed through retrospective chart review. Patients were stratified by potential risk factors for complications; outcomes were compared.

Results

Two hundred fifty-four axillary dissections in 239 patients were identified. Assessed risk factors for complications included age > 55 years (n = 133, 52%), body mass index (BMI) ≥ 30 kg/m2 (n = 90, 40%), diabetes (n = 40, 16%), smoking (n = 81, 32%), extremity primary (n = 71, 28%), therapeutic lymphadenectomy (n = 105, 41%), and adjuvant radiation (n = 33, 13%). Wound complications were observed in 51 patients with 38 (15%) seromas, 3 (1%) dehiscences, and 10 (4%) hematomas. There were 5 (2%) reoperations, all for hematoma. Thirty-day readmission rate was 6% (n = 14). Importantly, lymphedema occurred in only 13 (5%) patients. Wound dehiscence occurred only in smokers (p = 0.03) and was associated with adjuvant radiation (p = 0.04). Twenty-eight (11%) patients developed frozen shoulder, which was related to smoking (p = 0.02). Lymphedema was more likely in patients after therapeutic dissection (p = 0.04). All other risk factors were not associated with increased complications.

Conclusions

This analysis supports historical data that axillary dissection for melanoma is a low-risk procedure, with smoking, therapeutic lymphadenectomy, and adjuvant radiation associated with increased morbidity. Although morbidity of lymphadenectomy is often cited as a reason to alter surgical approach or even forgo intervention, this may be less of a concern for axillary dissection.

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Acknowledgement

This study was supported in part by the Katz Foundation.

Disclosures

The authors have no relevant disclosures.

Funding

This work was supported in part by the Katz Foundation.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Lauren M. Postlewait MD, Clara R. Farley MD, Alexandra M. Seamens MD, Nina Le BS, Monica Rizzo MD, Maria C. Russell MD, Michael C. Lowe MD & Keith A. Delman MD

  2. Division of Surgical Oncology, Winship Cancer Institute, 1365C Clifton Road NE, 2nd Floor, Atlanta, GA, 30322, USA

    Keith A. Delman MD

Authors
  1. Lauren M. Postlewait MD
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  2. Clara R. Farley MD
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  3. Alexandra M. Seamens MD
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  4. Nina Le BS
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  5. Monica Rizzo MD
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  6. Maria C. Russell MD
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  7. Michael C. Lowe MD
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  8. Keith A. Delman MD
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Corresponding author

Correspondence to Keith A. Delman MD.

Additional information

Drs. Postlewait and Farley contributed equally to this publication.

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Postlewait, L.M., Farley, C.R., Seamens, A.M. et al. Morbidity and Outcomes Following Axillary Lymphadenectomy for Melanoma: Weighing the Risk of Surgery in the Era of MSLT-II. Ann Surg Oncol 25, 465–470 (2018). https://doi.org/10.1245/s10434-017-6242-3

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  • DOI: https://doi.org/10.1245/s10434-017-6242-3

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