Surgeon decision-making for management of positive sentinel lymph nodes in the post-Multicenter Selective Lymphadenectomy Trial II era: A survey study

Jane Yuet Ching Hui, Erin Burke, Kristy K. Broman, Schelomo Marmor, Eric Jensen, Todd M. Tuttle, Jonathan S. Zager

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Completion lymph node dissection (CLND) did not improve melanoma-specific survival for patients with sentinel lymph node (SLN)-positive melanoma in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II). We assessed surgeons’ awareness of MSLT-II and its impact on CLND recommendations. Methods: An anonymous online cross-sectional survey of the Society of Surgical Oncology membership evaluated surgeon thresholds in offering CLND using patient scenarios and clinicopathologic characteristics ranking. Results: Of the 2881 e-mails delivered, 146 surgeons (5.1%) completed all seven scenarios. Most (129 of 131, 98%) were aware of MSLT-II and 125 (95%) found it practice-changing. Specifically, 52% (65 of 125) always, 40% usually, 6% rarely, and 3% never offered CLND before MSLT-II. Meanwhile, 4% always, 9% usually, 78% rarely, and 8% never offer CLND now, after MSLT-II (p <.0001). The most important clinicopathologic factors in determining CLND recommendations were extracapsular extension, number of positive SLN, and SLN tumor deposit size, while primary tumor mitotic index and nodal basin location were the least important. Surgical oncology fellowship training, melanoma patient volume, and academic center practice also influenced CLND recommendations. Conclusions: Most surgeon respondents are aware of MSLT-II, but its application in practice varies according to several clinicopathologic and surgeon factors.

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalJournal of Surgical Oncology
Volume123
Issue number2
Early online dateDec 1 2020
DOIs
StateE-pub ahead of print - Dec 1 2020

Bibliographical note

Funding Information:
This study was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health's National Center for Advancing Translational Sciences. Dr. Zager receives research funding from Delcath Systems, Provectus, Philogen, Amgen, Castle Biosciences, and Novartis; and grant funding from Delcath Systems.

Keywords

  • lymphadenectomy
  • lymphatic metastases
  • melanoma
  • sentinel lymph node
  • surgery

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