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Kfir U, Ronen O. Intraparotid Sentinel Lymph Node Dissection for Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15668-0. [PMID: 38954096 DOI: 10.1245/s10434-024-15668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Surgical management of head and neck cutaneous melanoma (HNCM) has evolved tremendously since sentinel lymph node biopsy (SLNB) has become the prominent tool of prognosis and staging. This meta-analysis aimed to evaluate the safety and efficiency of intraparotid SLNB compared with a more extensive surgery of superficial parotidectomy (SP). METHODS The electronic database of PubMed and Scopus were searched for publications until 10 March 2022. In addition, the study included data of patients from our institution who underwent cherry-picking procedures. Pooled estimates were calculated using the random-effects model. Heterogeneity was calculated using the I2 test. RESULTS The pooled result regarding the rate of SLNB excision success was 97 % (95 % confidence interval [CI], 0.95-0.99; p < 0.0001), and the pooled probability of a positive SLNB result was 16 % (95 % CI 0.12-0.20; p < 0.0001). Failure of SLNB had pooled results of 4 % (95 % CI 0.02-0.06; p < 0.0009). For SP, no study examining N0 HNCM patients has met the authors' inclusion criteria. Cherry-picking SLNB had temporary and permanent facial nerve paralysis relative risks (RRs) of 0.12 (95 % CI 0.06-0.27; p < 0.0001) and 0.46 (95 % CI 0.17-1.22; p < 0.0001), respectively, compared with historical data from four weighted meta-analyses of SP. CONCLUSIONS The data from this study suggest that intraparotid SLNB performed for N0 HNCM patients is a safe and reliable procedure, with very low complication rates. Failure of the procedure did not exceed 4 %. Therefore, intraparotid SLNB may be superior to an extensive surgery such as SP and should be examined in future prospective trials.
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Affiliation(s)
- Uriel Kfir
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, 221001, Nahariya, Israel.
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Chang BA, Asarkar AA, Nagel TH, Nathan CAO. Should Neck Dissection Be Done After Positive Sentinel Node Biopsy for Head and Neck Melanoma? Laryngoscope 2022; 132:2162-2163. [PMID: 35146747 DOI: 10.1002/lary.30053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Brent A Chang
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A.,Department of Surgery, Otolaryngology Section, Overton Brooks Veterans Affairs Medical Center (OBVAMC), Shreveport, Louisiana, U.S.A
| | - Thomas H Nagel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Cherie-Ann O Nathan
- Department of Otolaryngology/Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A.,Department of Surgery, Otolaryngology Section, Overton Brooks Veterans Affairs Medical Center (OBVAMC), Shreveport, Louisiana, U.S.A
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Farlow JL, McLean SA, Peddireddy N, Bradford CR, Malloy KM, Stucken CL, VanKoevering KK, Spector ME, Rosko AJ. Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma. Otolaryngol Head Neck Surg 2021; 166:313-320. [PMID: 33874791 DOI: 10.1177/01945998211007442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Recent randomized data suggest that completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) improves locoregional control but does not improve survival for melanoma patients. Locoregional recurrences of head and neck cutaneous melanoma (HNCM) may result in significant morbidity. A better understanding of morbidity is thus important to inform decisions about whether to pursue completion neck dissection (ND). STUDY DESIGN Cross-sectional study. SETTING Academic tertiary care hospital. METHODS Clinical data were collected for patients with HNCM seen between 2016 and 2019 who were at least 1-year disease free. Each patient completed the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), Neck Dissection Impairment Index, and SF-36 (Short Form-36). Scores were compared by surgical treatment: wide local excision (WLE) only, SLNB, and ND. Univariate and multivariable regression was performed. RESULTS Of 474 patients, 140 returned questionnaires (29.5% response rate; WLE, n = 49; SLNB, n = 76; ND, n = 15). No significant differences in SLANSS or Neck Dissection Impairment Index scores were found between the WLE and SLNB groups. SLANSS scores differed by 2 SD (P = .001) in the ND cohort, which had a 36% rate of neuropathy. Neck impairment was worse by 1 SD (P = .01) in the ND cohort. No differences were found in SF-36 domains. CONCLUSION Neuropathy and neck impairment are components of morbidity after ND. These risks must be balanced with potential morbidity of locoregional recurrence in HNCM.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Nithin Peddireddy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Bredbeck BC, Mubarak E, Zubieta DG, Tesorero R, Holmes AR, Dossett LA, VanKoevering KK, Durham AB, Hughes TM. Management of the positive sentinel lymph node in the post-MSLT-II era. J Surg Oncol 2020; 122:1778-1784. [PMID: 32893366 DOI: 10.1002/jso.26200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The publication of MSLT-II shifted recommendations for management of sentinel lymph node biopsy positive (SLNB+) melanoma to favor active surveillance. We examined trends in immediate completion lymph node dissection (CLND) following publication of MSLT-II. METHODS Using a prospective melanoma database at a high-volume center, we identified a cohort of consecutive SLNB+ patients from July 2016 to April 2019. Patient and disease characteristics were analyzed with multivariate logistic regression to examine factors associated with CLND. RESULTS Two hundred and thirty-five patients were included for analysis. CLND rates were 67%, 33%, and 26% for the year before, year after, and second-year following MSLT-II. Factors associated with undergoing CLND included primary located in the head and neck (59% vs 33%, P = .003 and odds ratio [OR], 5.22, P = .002) and higher sentinel node tumor burden (43% vs 10% for tumor burden ≥0.1 mm, P < .001 and OR, 8.64, P = .002). CONCLUSIONS Rates of CLND in SLNB+ melanoma decreased dramatically, albeit not uniformly, following MSLT-II. Factors that increased the likelihood of immediate CLND were primary tumor located in the head and neck and high sentinel node tumor burden. These groups were underrepresented in MSLT-II, suggesting that clinicians are wary of implementing active surveillance recommendations for patients perceived as higher risk.
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Affiliation(s)
| | - Eman Mubarak
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | | | - Adam R Holmes
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan
| | - Kyle K VanKoevering
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan.,Department of Otolaryngology, Michigan Medicine, Ann Arbor, Michigan
| | - Alison B Durham
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, Michigan
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Hanks JE, Kovatch KJ, Ali SA, Roberts E, Durham AB, Smith JD, Bradford CR, Malloy KM, Boonstra PS, Lao CD, McLean SA. Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety. Otolaryngol Head Neck Surg 2020; 162:520-529. [PMID: 32041486 DOI: 10.1177/0194599819899934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. SUBJECTS AND METHODS Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007. RESULTS Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P < .01), immunosuppression (HR, 2.37; P < .01), angiolymphatic invasion (HR, 1.91; P < .01), and ulceration (HR, 1.86; P < .01). SLN positivity (HR, 3.13; P < .01), angiolymphatic invasion (HR, 3.19; P < .01), and number of mitoses (P = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P < .01) and SLN status (HR, 2.84; P < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P < .01). CONCLUSIONS Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.
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Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kevin J Kovatch
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - S Ahmed Ali
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Emily Roberts
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison B Durham
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA.,University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher D Lao
- Department of Medical Oncology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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