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Elective Lymph Node Dissection in Patients With Melanoma
Systematic Review and Meta-analysis of Randomized Controlled Trials
Marko B. Lens, MD;
Martin Dawes, MD;
Tim Goodacre, MD;
Julia A. Newton-Bishop, MD
Arch Surg. 2002;137:458-461.
Hypothesis Elective lymph node dissection does not improve survival in patients with melanoma without clinically detectable lymph node metastases.
Objective To determine whether elective lymph node dissection in patients with melanoma without clinically detectable regional metastases decreases overall mortality.
Design Systematic review and meta-analysis of randomized controlled trials comparing elective lymph node dissection with delayed lymphadenectomy at the time of clinical recurrence.
Setting Randomized controlled trials available by February 2001.
Subjects The included trials comprised 1533 participants.
Intervention Elective lymph node dissection compared with delayed lymphadenectomy or no lymphadenectomy in patients with melanoma without clinically detectable regional metastases.
Main Outcome Measure Overall mortality in treatment groups as compared with control groups at the end of a 5-year follow-up period.
Results Three randomized controlled trials met the inclusion criteria. The pooled odds ratio for overall mortality for the 3 trials was 0.86 (95% confidence interval, 0.68-1.09). Results are statistically nonsignificant, but they have potential clinical significance.
Conclusions This systematic review of randomized controlled trials comparing elective lymph node dissection with surgery delayed until the time of clinical recurrence shows no significant overall survival benefit for patients undergoing elective lymph node dissection. Trials included in this review, however, contain significant bias. The question is not answered for all patients, and the results do not exclude the possibility that some subgroups may benefit from elective lymph node dissection. Further research is required.
From the Centre for Evidence-Based Medicine, University of Oxford Nuffield Department of Clinical Medicine, the Oxford Radcliffe National Health Service Trust, Oxford, England (Drs Lens, Dawes, and Goodacre), and the Genetic Epidemiology Division, Imperial Cancer Research Fund Clinical Centre, St James's University Hospital, Leeds, England (Dr Newton-Bishop).
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