Summary
Background
Sentinel lymph node biopsy is an established technique for melanoma staging.
Objective
There are no studies available comparing different techniques for the removal of sentinel lymph nodes related to safety and postsurgical complication rate.
Methods
This is a retrospective single-center trial. We analyzed the postsurgical complications in 201 consecutive melanoma patients with ligature of lymphatic vessels by sutures (group A) and in 91 consecutive patients with occlusion of lymphatic vessels by bipolar tweezers (group B). We paid particular attention to complications related to disturbed lymphatic function, such as lymph edema, lymphatic fistula, and seroma.
Results
The complication rate was 5.5 % (group A) and 9.6 % (group B) which is in the range of other published trials (p = 0.89). There was no increase of complications related to lymphatic vessels in group B, although the rate of patients with more than two sentinel lymph nodes removed was 5‑times higher than in group A.
Conclusions
Removal of sentinel lymph nodes with the use of bipolar tweezers does not increase the risk of postsurgical complications, and in particular it is not associated with a higher rate of complications related to lymphatic vessel dysfunction.
Zusammenfassung
Grundlagen
Die Sentinel-Lymphonodektomie ist ein etabliertes Verfahren im Rahmen des Melanom-Stagings.
Fragestellung
Bisher existieren keine Studien, in denen unterschiedliche Techniken zur Entnahme des Sentinel-Lymphknotens bezüglich Sicherheit und postchirurgischer Komplikationen verglichen werden.
Methodik
Es handelt sich um eine retrospektive Auswertung. Die Autoren untersuchten postchirurgische Komplikationen bei 201 konsekutiven Melanompatienten mit einer Fadenligatur der Lymphgefäße (Gruppe A) und bei 91 konsekutiven Patienten, bei denen die Lymphgefäße durch die bipolare Pinzette thermisch verschlossen wurden (Gruppe B). Besondere Aufmerksamkeit wurde hierbei den Komplikationen durch Störung des Lymphflusses, wie Lymphödem, Lymphfistel und Serom, gewidmet.
Ergebnisse
Die Komplikationsrate betrug 5,5 % (Gruppe A) und 9,6 % (Gruppe B) (p = 0,89), was in einem Bereich wie bei anderen publizierten Studien liegt. In Gruppe B fand sich keine Zunahme von Komplikationen, die auf lymphatische Störungen zurückzuführen waren, obwohl die Rate der Patienten mit einer Entnahme von mehr als 2 Sentinel-Lymphknoten 5‑mal höher lag als in Gruppe A.
Schlussfolgerungen
Die Entnahme des Sentinel-Lymphknotens mit bipolarer Pinzette statt Fadenligatur erhöht nicht das Risiko für postchirurgische Komplikationen allgemein und insbesondere auch nicht für Komplikationen, die durch Lymphstörungen bedingt sind.
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U. Wollina, D. Langner, J. Schönlebe, C. Tanner, M. Fuchs and A. Nowak declare that they have no competing interests.
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Wollina, U., Langner, D., Schönlebe, J. et al. Sentinel lymph node biopsy in early melanoma—comparison of two techniques for sentinel removal. Wien Med Wochenschr 167, 100–103 (2017). https://doi.org/10.1007/s10354-016-0499-1
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DOI: https://doi.org/10.1007/s10354-016-0499-1
Keywords
- Malignant melanoma
- Lymph node excision
- Sentinel lymph node biopsy
- Postsurgical complications
- Lymphatic vessels