Highlights
- •Lymph node dissection (LND) is currently standard of care for stage IIIB-D melanoma.
- •Neoadjuvant systemic therapy (NAST) has shown high response rates in melanoma.
- •Surgical outcomes of LND after NAST are comparable to upfront surgery.
Abstract
Background
Neoadjuvant systemic therapy has shown promising results in the treatment of high-risk
stage III melanoma; however, the effects on surgery are currently unknown. This study
aims to compare the surgical outcomes, in terms of postoperative complications, postoperative
morbidity, duration of surgery and textbook outcomes, of patients with high-risk stage
III melanoma who received neoadjuvant systemic therapy followed by lymph node dissection
with patients who received an upfront lymph node dissection.
Methods
In this retrospective cohort study, patients with high-risk stage III melanoma treated
with neoadjuvant anti-PD1 and anti-CTLA4 in the OpACIN (NCT02437279) and OpACIN-neo
(NCT02977052) trial between October 2014 and August 2018 were included and compared
to patients who received upfront surgery in the same time period.
Results
A total of 120 patients were included in this study, of whom 44 received neoadjuvant
systemic therapy and 76 underwent upfront surgery. There was no significant difference
in the overall rate of postoperative complications between the neoadjuvant group and
the upfront surgery group (31.8% versus 36.8%, p = 0.578) and neither in rate of postoperative
morbidity (seroma 56.8% versus 57.9%, p = 0.908) (lymphedema 22.7% versus 13.2%, p = 0.175).
There was a non-significant difference towards a slightly longer duration of surgery
after neoadjuvant immunotherapy (105 versus 90 min, p = 0.077). There were no differences
in textbook outcomes (50% versus 49%, p = 0.889).
Conclusion
This study shows that the surgical outcomes for patients who underwent a lymph node
dissection after neoadjuvant systemic immunotherapy or underwent upfront lymph node
dissection for high-risk stage III melanoma are comparable.
Keywords
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Article info
Publication history
Published online: March 07, 2023
Accepted:
March 1,
2023
Received in revised form:
February 28,
2023
Received:
November 11,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
