Outcomes following therapeutic lymphadenectomy for Stage III malignant melanoma in a single unit

Malignant melanoma is the fourth most common cancer in New Zealand. Surgery is the only treatment modality that can achieve high cure rates for regional disease, but is associated with high complication rates. Our study documents the morbidity associated with regional lymphadenectomy; audits nodal harvest numbers and considers nodal harvest targets.

We retrospectively reviewed regional lymphadenectomies for Stage III melanoma at a single tertiary centre from 2004 to 2014. Data was collected on patient demographics, site of operation, number of lymph nodes recovered, all complications within six months of surgery, loco-regional recurrence, distal progression and five-year survival. We also used key performance indicators (KPI) to assess the quality of dissection.

A total of 219 lymphadenectomies were carried out. Forty-three percent of all patients experienced at least one complication. This was markedly higher for those undergoing a groin dissection. Recurrence, progression and survival rates did not vary between nodal basins. There was a mean of 31.6, 17.6 and 10.9 nodes recovered from neck, axillary and groin dissection groups respectively. Our KPIs were achieved in 80%, 86.6% and 90% of cases and resulted in a significant improvement in recurrence and progression rates.

Lymphadenectomy has a high risk of post-operative complications, especially for groin dissections. Quality of lymphadenectomy can be assessed by monitoring nodal harvest numbers, and achieving nodal harvest targets provides significant prognostic information. We support the development of national tumour standards, including key performance indicators, for management of Stage III melanoma.