Morbidity and Outcomes Following Axillary Lymphadenectomy for Melanoma: Weighing the Risk of Surgery in the Era of MSLT-II

• Published in: Annals of surgical oncology 2018-02, Vol.25 (2), p.465-470
• Main Authors: Postlewait, Lauren M., Farley, Clara R., Seamens, Alexandra M., Le, Nina, Rizzo, Monica, Russell, Maria C., Lowe, Michael C., Delman, Keith A.
• Format: Article
• Language: English
• Subjects: Axilla; Biopsy; Body mass index; Breast cancer; Data processing; Decision making; Dehiscence; Diabetes mellitus; Dissection; Female; Follow-Up Studies; Hematoma; Humans; Lymph Node Excision - adverse effects; Lymphedema; Lymphedema - etiology; Lymphedema - pathology; Lymphedema - surgery; Male; Medicine; Medicine & Public Health; Melanoma; Melanoma - complications; Melanoma - pathology; Melanoma - surgery; Melanomas; Middle Aged; Morbidity; Oncology; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Smoking; Surgery; Surgical Oncology; Wounds
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-6242-3

Background Limited data exist characterizing complications after axillary lymphadenectomy for melanoma. With high rates of complications reported after dissection for breast cancer and data suggesting that completion lymphadenectomy may have limited therapeutic benefit, this study characterized morbidity to facilitate clinical decision-making. Methods Using a broad definition for complications, patients who underwent axillary dissection for melanoma at a single center (from 2003 to 2015) were assessed through retrospective chart review. Patients were stratified by potential risk factors for complications; outcomes were compared. Results Two hundred fifty-four axillary dissections in 239 patients were identified. Assessed risk factors for complications included age > 55 years ( n  = 133, 52%), body mass index (BMI) ≥ 30 kg/m 2 ( n  = 90, 40%), diabetes ( n  = 40, 16%), smoking ( n  = 81, 32%), extremity primary ( n  = 71, 28%), therapeutic lymphadenectomy ( n  = 105, 41%), and adjuvant radiation ( n  = 33, 13%). Wound complications were observed in 51 patients with 38 (15%) seromas, 3 (1%) dehiscences, and 10 (4%) hematomas. There were 5 (2%) reoperations, all for hematoma. Thirty-day readmission rate was 6% ( n  = 14). Importantly, lymphedema occurred in only 13 (5%) patients. Wound dehiscence occurred only in smokers ( p  = 0.03) and was associated with adjuvant radiation ( p  = 0.04). Twenty-eight (11%) patients developed frozen shoulder, which was related to smoking ( p  = 0.02). Lymphedema was more likely in patients after therapeutic dissection ( p  = 0.04). All other risk factors were not associated with increased complications. Conclusions This analysis supports historical data that axillary dissection for melanoma is a low-risk procedure, with smoking, therapeutic lymphadenectomy, and adjuvant radiation associated with increased morbidity. Although morbidity of lymphadenectomy is often cited as a reason to alter surgical approach or even forgo intervention, this may be less of a concern for axillary dissection.