Journal Article

The Effect of Neoadjuvant Systemic Therapy on Surgical Outcomes After Lymph Node Dissections for Stage III Melanoma; An Australian Cohort

Ferguson, Peter, Saw, Robyn P. M., Thompson, John F., Zijlker, Lisanne P., Nieweg, Omgo, Spillane, Andrew J., Menzies, Alexander M., Gonzalez, Maria, Lo, Serigne N., Pennington, Thomas E., Rawson, Robert, Chen, Henry, van Akkooi, Alexander C. J., Ch’ng, Sydney, Scolyer, Richard A., Colebatch, Andrew J., Stretch, Jonathan R., Shannon, Kerwin F., Long, Georgina V.

2024

Overview

Background Neoadjuvant systemic therapy (NAST) for patients with stage III melanoma achieves high major pathologic response rates and high recurrence-free survival rates. This study aimed to determine how NAST with targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) influences surgical outcomes after lymph node dissection in terms of complications, morbidity, and textbook outcomes. Methods Patients who underwent a lymph node dissection after either NAST in a clinical trial or upfront surgery for stage III melanoma between 2014 and 2022 were identified from an institutional research database. Results The study included 89 NAST-treated patients and 79 upfront surgery-treated patients. The rate of postoperative complications did not differ between the NAST- and upfront surgery-treated patients (55% vs. 51%; p  = 0.643), and steroid treatment for drug toxicity did not influence the complication rate (odds ratio [OR], 1.1; 95% confidence interval [CI], 0.4–3; p  = 0.826). No significant differences in postoperative morbidity were observed in terms of seroma (23% vs. 11%; p  = 0.570) or lymphedema (36% vs. 51%; p  = 0.550). The rate of achieving a textbook outcome was comparable for the two groups (61% vs. 57%; p  = 0.641). Conclusions The surgical outcomes after lymph node dissections were comparable between the patients who received NAST and those who had upfront surgery, indicating that surgery can be safely performed after NAST with TT or ICI for stage III melanoma.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Australia / Complications / Dissection / Female / Follow-Up Studies / Humans / Immune checkpoint inhibitors / Immune Checkpoint Inhibitors - therapeutic use / Lymph Node Excision / Lymph nodes / Lymphatic system / Lymphedema / Male / Medicine / Medicine & Public Health / Melanoma / Melanoma - drug therapy / Melanoma - mortality / Melanoma - pathology / Melanoma - surgery / Middle Aged / Morbidity / Neoadjuvant Therapy / Neoplasm Staging / Oncology / Patients / Postoperative / Postoperative Complications / Prognosis / Retrospective Studies / Skin Neoplasms - drug therapy / Skin Neoplasms - pathology / Skin Neoplasms - surgery / Surgery / Surgical Oncology / Surgical outcomes / Survival Rate / Toxicity