The study found that immediately removing and performing biopsies on all lymph nodes located near the original tumour, a procedure called 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, Mark Faries, co-director of the Melanoma Programme and head of Surgical Oncology at the Angeles Clinic and Research Institute, California. “The results also will likely affect the design of many current and future clinical trials of medical therapies in melanoma.”
More than 1,900 patients with melanoma participated in the study conducted at more than 60 medical institutions nationally and internationally. It addressed what Faries describes as the most important question facing physicians and those newly diagnosed with the disease: whether patients who have melanoma cells in a limited number of lymph nodes should undergo extensive surgery to remove all the remaining nodes in that area of the body. The results of the new research suggest they should not.
The new approach would spare patients significant negative side effects. Although the completion dissections did not help overall survival, they did have some value, Faries said. By examining the dissected lymph nodes, physicians were able to better gauge how extensively the cancer had spread and it did lengthen the time that patients remained disease-free. But those advantages did not translate into longer survival.
Additionally, nearly 25 percent of the patients who underwent the completion dissections suffered from lymphedema, compared with about 6 percent of the control group. Lymphedema is swelling that may result when lymph nodes are damaged or removed. Symptoms include hardening of the skin, infections and restricted range of motion.
The research is published here: http://www.nejm.org/doi/full/10.1056/NEJMoa1613210
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