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Identifying risk factors for complications following sentinel lymph node biopsy for melanoma
J Brent Roaten1, Nate Pearlman, Ricardo Gonzalez
1Department of Surgery and Medical Oncology, University of Colorado Health Sciences Center, Denver 80220, USA.
Background:
Sentinel lymph node biopsy has become routine in the staging of patients with cutaneous melanoma and is presumed to have fewer complications than elective regional lymph node dissection (RLND). However, little information is available to refute or support this assumption.
Hypothesis:
Risk factors for complications following sentinel lymph node biopsy (SLNBX) can be identified.
Design:
Retrospective medical record review.
Patients And Methods:
The medical records of 339 consecutive patients undergoing SLNBX for melanoma between 1996 and 2003 at our institution were reviewed for complications.
Results:
In our series of 339 patients, 20 complications (5.9%) were observed following SLNBX compared with 15 (19.5%) of 77 patients undergoing RLND during the same period (P<.001). Seroma formation, transient nerve injuries, and minor wound infections were the most frequently observed complications in patients undergoing SLNBX. In contrast, chronic lymphedema and wound infections were the most frequent complications observed in patients undergoing RLND. Patients with comorbid medical conditions had more complications following either SLNBX or RLND than those without. The number of lymph nodes excised and the placement of closed-suction drainage were associated with an increased incidence of complications following SLNBX but not RLND. The incidence of annual complications inversely correlated with the cumulative number of SLNBXs performed during this period.
Conclusions:
Sentinel lymph node biopsy can be performed with a low incidence of complications. Experience with SLNBX decreases complications. Patients with more than 1 sentinel lymph node excised or a closed-suction drain placed at the time of SLNBX are at an increased risk of complications.