Rødgaard Jes C, Kramer Stine, Stolle Lars B
Department of Plastic Surgery and Reconstruction, Aarhus University Hospital , Aarhus , Denmark.
J Plast Surg Hand Surg. 2014 Aug;48(4):265-9. doi: 10.3109/2000656X.2013.870910. Epub 2013 Dec 16.
The aim of this study was to compare a delayed sentinel node biopsy (dSNB) procedure with a same-day procedure (sSNB) in malignant melanoma. In March 2012, Aarhus University Hospital went from the dSNB to the sSNB procedure defined by lymphoscintigraphy (LS) and sentinel node biopsy (SNB) performed on the same day. Before that time, LS was performed 24 hours prior to SNB. The aim was to investigate whether differences between the two procedures exist. Patients who underwent the SNB procedure between April and July 2011 and 2012, respectively, were included in the study. The criteria for SNB were malignant melanoma thickness >1 mm, Clark level IV/V, and ulcus or unknown thickness of the melanoma. All patients underwent re-excision and SNB at the same time. Pathological evaluation was not changed in the observation periods; however, the LS procedures varied. Only a minor turnover among the surgeons was observed. One hundred and eight patients were included in the study, 59 (dSNB) from 2011 and 49 (sSNB) from 2012, respectively. A median of 2.17 (dSNB) and 2.31 (sSNB) SLNs were removed, with no statistical differences. No difference in node positivity rates was observed. However, the number of hospitalisation days differed significantly, with 1.94 days in dSNB and 0.49 days in sSNB. Rates of complications at the site of the SNB procedure were similar. No differences in disease-free survival (DFS) or overall survival (OS) were recorded. SNB does not increase the overall survival. It is, therefore, essential to keep the morbidity and economic costs low, while keeping the quality of the procedure high.
本研究的目的是比较恶性黑色素瘤的延迟前哨淋巴结活检（dSNB）与同日活检（sSNB）。2012年3月，奥胡斯大学医院从延迟前哨淋巴结活检改为通过淋巴闪烁显像（LS）和同日进行前哨淋巴结活检（SNB）所定义的同日活检程序。在此之前，淋巴闪烁显像在进行前哨淋巴结活检前24小时进行。目的是调查这两种程序之间是否存在差异。分别在2011年4月至7月和2012年4月至7月接受前哨淋巴结活检程序的患者被纳入研究。前哨淋巴结活检的标准为恶性黑色素瘤厚度>1mm、克拉克分级IV/V级以及黑色素瘤溃疡或厚度不明。所有患者同时接受再次切除和前哨淋巴结活检。在观察期内病理评估未改变；然而，淋巴闪烁显像程序有所不同。仅观察到外科医生中有少量人员变动。108名患者被纳入研究，分别为2011年的59名（dSNB）和2012年的49名（sSNB）。切除的前哨淋巴结数量中位数分别为2.17（dSNB）和2.31（sSNB），无统计学差异。未观察到淋巴结阳性率的差异。然而，住院天数有显著差异，dSNB为1.94天，sSNB为0.49天。前哨淋巴结活检部位的并发症发生率相似。无疾病生存率（DFS）或总生存率（OS）的差异记录。前哨淋巴结活检不会提高总生存率。因此，在保持手术质量高的同时，将发病率和经济成本保持在低水平至关重要。
