O044 The risk of surgical site infection and other wound complications following surgery to the lymph nodes for staging or treatment of malignancy: a systematic review and meta-analysis of 45,415 cases

Abstract

Abstract Introduction For completion of staging of malignant melanoma, sentinel lymph node biopsy (SLNB) may be offered to patients with stage 1B disease or greater, and in some positive cases, completion lymphadenectomy is offered. However, there is little evidence that either procedure are beneficial to patients, and both procedures carry a risk of wound complications. The aim of this study was to assess the current prevalence of wound complications in these procedures and quantify the change over time of this risk. Methods This was a subgroup analysis of a larger systematic review (Prospero CRD42021239530). A systematic search was undertaken to identify all published material relating to surgery on the lymph nodes. The primary outcome was the proportion of surgical site infection and/or seroma. Studies relating to malignant melanoma were selected from the overall results, and random effects meta-analysis of proportions and meta-regression were undertaken. Results Seventy studies were suitable for inclusion in meta-analysis, constituting 7,585 patients. The proportion of patients developing infection following SLNB was 3.5% (95% CI 2.0–6.0%) and seroma 7.8% (4.0–14.3%). For completion lymphadenectomy, the risk of SSI was 17.4% (13.4– 22.2%) and seroma 24.7% (23.4–26.0%). Neither SSI nor seroma incidence have changed significantly in 30 years. Conclusion The risk of complications in these procedures remains high and has not changed in 30 years. Given a potential lack of benefit of these procedures, this data should be used as part of the decision-making process when counselling patients, and to guide future research into prevention of wound complications. Take-home message The risk of SSI following block dissection for melanoma is almost 20%, and the risk of seroma almost 25%. This unacceptably high risk has not improved in the last 30 years.