Morbidity of Lymph Node Surgery in Melanoma

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Complications associated with sentinel lymph node biopsy (SLNB) for melanoma:
    • Were evaluated in 2,120 patients in an analysis of data from the Sunbelt Melanoma Trial:
      • Overall, 96 (4.6%) of the patients developed major or minor complications associated with SLNB:
        • Whereas 103 (23.3%) of 444 patients experienced complications associated with SLNB plus completion lymph node dissection
      • The authors concluded that:
        • SLNB alone is associated with significantly less morbidity compared to SLNB plus completion lymph node dissection
    • Similar to the Sunbelt Melanoma Trial, in MSLT-1:
      • SLNB did not significantly add to the morbidity of melanoma surgery when compared to wide excision of the primary melanoma alone
  • Formal lymphadenectomy is associated with higher complication rates than SLNB, and includes:
    • Seroma
    • Wound infection
    • Cellulitis
    • Lymphedema
    • Skin flap problems:
      • That may on occasion require surgical revision
  • Complication rates are higher in the:
    • Inguinal region than in the axilla or neck:
      • Cormier et al. prospectively followed 53 patients at MD Anderson who underwent inguinal lymphadenectomy for melanoma:
        • Using liberal objective criteria, investigators found the:
          • Acute wound complication rate to be 77.4% with a wound infection rate of 54.7% and a wound dehiscence rate of 52.8%
        • In multivariate analysis, only body mass index was found to be associated with an increase in complications
    • The infection rate reported after lymphadenectomy in MSLT-1 was 12%:
      • They noted that lymphedema rates varied significantly depending on the lymph nodes basins that were dissected:
        • 9.0% for axillary lymphadenectomy vs. 26.6% for inguinal lymphadenectomy)
  • Lymphedema is among the most serious long-term complications of formal lymphadenectomy:
    • Inguinal lymphadenectomy associated lymphedema:
      • Was not altered significantly by the addition of a deep groin dissection
    • In addition, the number of lymph nodes removed:
      • Did not appear to alter the lymphedema rate significantly
  • In the study by Cormier et al:
    • The lymphedema rate at 3 months was 85% using qualitative measures and 45% by quantitative measures for patients who underwent inguinal lymphadenectomy
  • Lower extremity edema after groin dissection:
    • Can be decreased by preventive measures, including:
      • Perioperative antibiotics
      • Elastic stockings
      • Leg elevation exercises
      • On occasion, diuretics
    • Even with preventive measures, patients should be counseled that lymphedema can still develop
  • Nonetheless, prophylactic measures are important:
    • Because reversing the progression of lymphedema is difficult
  • The complication rate for axillary lymph node dissections is lower than that for inguinal dissection:
    • The most frequent complication is wound seroma:
      • Varying from 3% to 23%
    • Other common complications include:
      • Cellulitis and lymphedema (approximately 10%)
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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