Oral Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Declining rate of completion lymph node dissection post-publication of MSLT-II: A regional experience (838)

Eric Kim 1 , Jessica Papali'i-Curtin 1 , Will McMillan 1 , Patrick Lyall 1 , Rebecca Ayers 1 , Anne Collins 1
  1. Southern DHB, Dunedin, OTAGO, New Zealand

Background

Completion lymph node dissection (CLND) was performed very frequently in patients who had regional node metastases confirmed on a sentinel lymph node biopsy (SLNBx) in accordance with melanoma guidelines. However recent studies such as MSLT-II has found there were no significant differences in melanoma-specific survival between patients who underwent a CLND and patients who underwent observations with ultrasound scans.[1,2] In this study we conducted a retrospective analysis to assess whether the MSLT-II publication has influenced the rate of CLND in patients with positive SLNBx at Dunedin Hospital. The Department of Plastic Surgery at Dunedin Hospital performs majority of the SLNBx for melanoma in Otago and Southland regions.

Methods

We retrospectively collected data on SLNBx over a 12 year period from the February 2007 (appointment of the first Plastic Surgeon in Dunedin) to April 2019. We included all patients who had confirmed sentinel node metastases. Patients were allocated to pre-MSLT and post-MSLT groups. We recorded whether the patients underwent a CLND or observed with regular ultrasound scans as per protocol in MSLT-II.

Results

High proportion of patients in the pre-MSLT group underwent a CLND. Every patient in the post-MSLT group underwent observations with ultrasound.

Discussion

Rates of CLND dropped dramatically for patients with sentinel lymph node metastases after publication of MSLT-II. 

Conclusion

Although this is a study with small numbers, we found that MSLT-II has dramatically changed our management of patients with sentinel lymph node metastases at Dunedin Hospital. The implications for patients and utilisation of hospital resources are discussed.

  1. [1] Faries M, Thompson J, Cochran A, Andtbacka R, Mozzillo N, Zager J et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. New England Journal of Medicine. 2017;376(23):2211-2222.
  2. [2] Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. The Lancet Oncology. 2016;17(6):757-767.