The common practice of surgically removing all lymph nodes adjacent to a melanoma that has spread does not appear to improve patient survival, according to findings from a new study.
Published in The New England Journal of Medicine (June 8, 2017; 376:2211–2222), the study involved more than 1,900 patients with melanoma from more than 60 medical institutions.
Investigators found that immediately removing and performing biopsies on all lymph nodes located near the original tumour—a procedure known as completion lymph node dissection—did not result in increased overall survival rates.
“The new findings likely will result in many fewer of these procedures being performed around the world,” said the study’s lead author, Dr. Mark B. Faries, in a press release. Dr. Faries is co-director of the Melanoma Program and head of Surgical Oncology at The Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai Medical Center in Los Angeles. “The results also will likely affect the design of many current and future clinical trials of medical therapies in melanoma.”
As well, nearly 25% of patients who underwent completion dissections experienced lymphoedema—which can result in skin hardening, infections, and restricted range of motion—compared to controls. “This is a larger operation that has a higher risk of complications,” Dr. Faries said, “including wound infection and nerve damage.”
Less aggressive lymph node removal “spares patients significant negative side effects and clarifies the road forward in development of additional therapies,” said Dr. Omid Hamid, chief of Research/Immuno-Oncology at The Angeles Clinic and Research Institute and co-director of the Cedars-Sinai Cutaneous Malignancy Program, in the release.
While the completion dissections did not improve patient survival, they did provide some benefit, said Dr. Faries.
Examining the dissected lymph nodes allowed physicians to better evaluate the extent of the melanoma’s spread, as well lengthening the time that their patients were disease-free, he said.
Before complete sentinel node dissection was common, dissection of all regional lymph nodes at the early diagnosis of melanoma was the standard of care, according to the release. Today, lymphatic mapping techniques are utilized worldwide, and the removal of all regional nodes is undertaken only if the sentinel nodes are positive for cancer.
“The larger procedure will remain an option for some patients, but it will no longer be the only ‘standard’ option,” Dr. Faries said.