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Richter K, Stefura T, Macheta K, Tempski J, Kazoń J, Szeremeta M, Klimont P, Kołodziej-Rzepa M, Wojewoda T, Wysocki WM. Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11133880. [PMID: 35807174 PMCID: PMC9267433 DOI: 10.3390/jcm11133880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this meta-analysis was to answer the question as to whether performing CLND (complete lymph node dissection) is necessary in every case of the melanoma patient after the positive SNB (sentinel node biopsy). To resolve doubts the authors reanalyzed previous articles and systematized the knowledge about the concerning medical problem. The databases such as PubMed, Scopus and Web of Science were screened to find articles that will be helpful to answer the controversial question if performing lymphadenectomy is crucial. The inclusion criteria consisted of randomized clinical trials, comparison of lymphadenectomy versus observation and positive sentinel node biopsy. After which, seven articles were examined. Authors analyzed parameters such as: recurrence, 3-year survival and 5-year survival. There was no relationship between the performance of CLND and melanoma recurrence (OR 1.04; 95% CI: 0.82–1.31; p = 0.75). However, no CLND group had higher 3-year survival (OR 1.22; 95% CI: 1.03–1.44; p = 0.02) and 5-year survival (OR 1.30; 95% CI: 1.19–1.85; p = 0.008). In conclusion, the observational approach to the melanoma patients with positive sentinel node biopsy is associated with comparable or slightly improved 3- and 5-year survival, then in case of routine lymphadenectomy. Although, in each melanoma patient a decision to perform or withhold lymphadenectomy should always be considered individually. Patients with low perioperative risk could be considered for surgical approach. The study was registered in PROSPERO and was assigned with the unique identifying number “CRD42021241272”.
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Affiliation(s)
- Karolina Richter
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Tomasz Stefura
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-705 Krakow, Poland;
- Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College Kraków, 30-688 Krakow, Poland
| | - Krzysztof Macheta
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Jonasz Tempski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Jakub Kazoń
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Magdalena Szeremeta
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Paweł Klimont
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
| | - Marta Kołodziej-Rzepa
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-705 Krakow, Poland;
| | - Tomasz Wojewoda
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-705 Krakow, Poland;
| | - Wojciech M. Wysocki
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1, 30-705 Krakow, Poland; (K.R.); (K.M.); (J.T.); (J.K.); (M.S.); (P.K.); (M.K.-R.); (T.W.)
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-705 Krakow, Poland;
- Scientific Editorial Office, Maria Skłodowska-Curie Memorial, National Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland
- Correspondence:
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