Abstract
IntroductionThe complication rate after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) in melanoma patients is high. The aim of this randomized non-inferiority study was to evaluate the effect of postoperative wound drainage on early complications after ALND and ILND. Materials and methodsBetween 2018 and 2020, 104 stage III melanoma patients operated on with ALND or ILND were randomized to a study group with complete wound drain removal 3 wk after surgery or a control group with progressive drain removal. The primary end point was overall early complications graded according to the modified Clavien-Dindo classification. Secondary endpoints were length of hospital stay and prognostic factors for early complications. ResultsOf the 99 patients analyzed, ALND was performed in 58 patients and ILND in 41 patients. Overall, 62 patients (62.6%) developed early complications: 30 in the study group and 32 in the control group (P = 0.53). The confidence interval for the difference in proportions of patients without early complications in the two groups was −0.27 to 0.11 (P = 0.42), hence non-inferiority could be claimed. Length of hospital stay was 5 d in the study group compared to 6 in the control group (P < 0.01). ILND was associated with increased risk of early complications compared to ALND (75.6% versus 53.4%, P = 0.04). ConclusionsComplete drain removal 3 wk after ALN and ILND in stage III melanoma patients did not increase the risk of early complications compared to progressive drain removal.
Highlights
The complication rate after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) in melanoma patients is high
ILND was associated with increased risk of early complications compared to ALND (75.6% versus 53.4%, P = 0.04)
Complete drain removal 3 wk after ALN and ILND in stage III melanoma patients did not increase the risk of early complications compared to progressive drain removal
Summary
The complication rate after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) in melanoma patients is high. Lymph node dissection is the preferred treatment for stage III melanoma patients with macroscopic nodal disease.[1,2,3] Complications occur frequently after axillary lymph node dissection (ALND) and inguinal lymph node dissection (ILND) with reported complication rates up to 70%, with a consistent finding of higher complication rates in the groin than in the axilla.[4,5,6,7,8,9] Modifications have been proposed to the surgical procedure[10,11,12,13] and postoperative care protocols[5,14,15] in order to reduce the complication rate These approaches have failed to identify any single measure that significantly reduce complication rate. Minimizing the number of care providers in contact with the drain may be beneficial in terms of surgical site infection (SSI)
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