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Complete Lymph Node Dissection in Melanoma: A Systematic Review and Meta-Analysis.
Alberto Falk Delgado1, Anna Falk Delgado2
1Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden Alberto.falk-delgado@surgsci.uu.se.
Complete lymph node dissection (CLND) shows no survival benefit over observation (OO) for melanoma patients. However, early CLND may improve survival compared to delayed or no dissection in specific cases.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Melanoma with lymph node metastasis presents a treatment challenge.
- Management options include observation, immediate complete lymph node dissection (CLND), or delayed CLND.
Purpose of the Study:
- To evaluate survival outcomes comparing immediate CLND versus observation only (OO) or delayed CLND in melanoma patients with lymph node metastasis.
Main Methods:
- Systematic search of major databases (PubMed, Web of Science, Embase, etc.).
- Inclusion of four randomized controlled trials (RCTs) comparing CLND with OO, or immediate CLND with delayed CLND.
Main Results:
- No significant difference in melanoma-specific survival (MSS) between immediate CLND and OO (HR=0.91, p=0.29).
- Sensitivity analysis revealed improved MSS with immediate CLND versus delayed CLND in patients with nodal metastasis (HR=0.63, p=0.0004), with no heterogeneity.
Conclusions:
- Immediate CLND does not appear to offer additional survival benefit over OO after sentinel lymph node biopsy (SNB).
- Subgroup analysis indicates a potential time-dependent survival advantage for early surgical lymph node removal.
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