Surgeons’ Opinions on Lymphadenectomy in Melanoma Patients with Positive Sentinel Nodes: A Worldwide Web-Based Survey
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A worldwide web-based survey was conducted among melanoma surgeons to investigate opinions about completion lymph node dissection (CLND) in patients with positive sentinel nodes (SN).
A questionnaire was designed following input from a group of melanoma surgeons. Cognitive interviews and pilot testing were performed. Surgeons identified through a systematic-review of the SN and CLND literature were invited by email.
Of 337 surgeons, 193 (57.2 %) from 25 countries responded (January–July 2011). Most respondents work in melanoma (30.1 %) and surgical oncology (44.6 %) units. In patients with a positive SN, 169 (91.8 %) recommend CLND; the strength of the recommendation is mostly influenced by patient comorbidities (64.7 %) and SN tumor burden (59.2 %). Seventy-one responders enroll patients in the second Multicenter Selective-Lymphadenectomy Trial (MSLT-2), and 64 of them (76 %) suggest entering the trial to majority of patients. In cases requiring neck CLND, level 1–5 dissection is recommended by 35 % of responders, whereas 62 % base the extent of dissection on primary site and lymphatic mapping patterns. Only inguinal dissection or ilioinguinal dissection is performed by 36 and 30 % of surgeons, respectively. The remaining 34 % select either procedure according to number of positive SNs, node of Cloquet status, and lymphatic drainage patterns. Most surgeons (81 %) perform full axillary dissections in positive SN cases.
The majority of melanoma surgeons recommend CLND in SN-positive patients. Surgeons participating in the MSLT-2 suggest entering the trial to the majority of patients. More evidence is needed to standardize the extent of neck and groin CLND surgeries.
KeywordsMelanoma Sentinel Node Positive Sentinel Node Sentinel Node Metastasis Completion Lymph Node Dissection
SP was a research fellow at the MIA, he was supported by the Melanoma Foundation, and the Veneto Oncology Institute, Padova, Italy. AJS’s research is supported by The Friends of the Mater Foundation, North Sydney, NSW, Australia. The authors truly thank Prof. Simone Mocellin (University of Padova, Padova, Italy) and Dr. Antonio Sommariva (Veneto Institute of Oncology, Padova, Italy) for actively participating the testing and retesting phase. The authors are thankful to all the surgeons who took part in this survey, especially to the Head of the Department as they involved their collaborators in this project. A full list of participating institutions is reported in Appendix 2.
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