Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.
J Surg Oncol. 2012 Mar;105(3):225-8. doi: 10.1002/jso.22076. Epub 2011 Aug 22.
For melanoma patients with a positive axillary SLN, the extent of ALND remains controversial, with debate over whether a level III dissection is needed.
We queried our IRB approved prospective database for patients with a positive axillary SLN who had a level I/II dissection only, and compared recurrence and complication rates to the existing literature.
Between 1998 and 2008, 270 patients had 285 level I/II ALNDs for a positive SLN. Median number of SLN removed was 2, while the median number of involved SLN was 1 (range 1-4). An average of 18.7 nodes/ALND were removed, with 13% having positive non-SLN. Post-operative complications occurred in 31 patients (11%), primarily cellulitis (8%). After a mean follow-up of 44 months, 14 patients had a regional recurrence in the axillary basin (5%).
The complication rate and regional recurrence rate for patients undergoing a level I/II ALND for a positive SLN are either lower than or on par with reported series of ALND for level I, II, and III dissections, suggesting that in this setting, the level III dissection may be of minimal benefit.
对于前哨淋巴结阳性的黑色素瘤患者，腋窝淋巴结清扫术（ALND）的范围仍存在争议，是否需要进行 III 水平的清扫术存在争议。
我们查询了经过机构审查委员会批准的前瞻性数据库，以确定仅进行了 I/II 水平 ALND 且前哨淋巴结阳性的患者，并将复发率和并发症发生率与现有文献进行了比较。
1998 年至 2008 年间，270 例患者共进行了 285 例 I/II 水平 ALND 以治疗前哨淋巴结阳性。切除的 SLN 中位数为 2 个，而受累 SLN 的中位数为 1 个（范围为 1-4 个）。平均每例 ALND 切除 18.7 个淋巴结，13%的非 SLN 有阳性。31 例（11%）患者发生术后并发症，主要为蜂窝织炎（8%）。平均随访 44 个月后，14 例患者在前哨淋巴结阳性的腋窝区域出现局部复发（5%）。
对于前哨淋巴结阳性的黑色素瘤患者，接受 I/II 水平 ALND 的患者的并发症发生率和局部复发率与 I、II 和 III 水平 ALND 的报道系列相似或更低，这表明在这种情况下，III 水平的清扫术可能益处有限。
