Vor dem Hintergrund der Sentinel-Lymphonodektomie : Eine 20-Jahres-Bilanz der elektiven Lymphknotendissektion beim malignen Melanom

Background: The Sentinel-lymph node biopsy is increasingly displacing the elective lymph node dissection (ELND). Therefore we analyzed the efficacy of ELND in the treatment of malignant melanoma of the trunk. Methods: Between 1979 and 1998, 290 patients (200 male) with an average age of 49 years underwent surgery because of UICC-stage I (pT2) to stage III melanoma that was located on the trunk. Our retrospective analysis was based on those 247 patients who had been followed up in our medical center. Results: In 26 of 67 patients suffering from a pT2-tumor, ELND had been performed. In none of these patients (0/22) lymph node metastases were found. 4 of the 67 pT2-patients died because of metastases of the melanoma, 2 of them after ELND within the follow-up period (median 98 months). In 106 of our 116 patients suffering from pT3-tumor, a lymph-node-dissection was performed, in 96 of them electively. 13 of the 96 patients undergoing ELND had clinically not detectable lymph node metastases. 13 out of the 83 pT3N0- and 7 out of the 13 pT3N1-patients are deceased. In 59 of 64 patients suffering from pT4-tumor, a lymphnode-dissection was performed, in 44 of them electively. In 13 of these 44 patients lymphnode metastases were found. 15 out of the 31 pT4N0- and 7 out of the 13 pT4N1-patients died within the follow-up period. The 5-year survival rate amounted to 78% for all patients. For patients suffering from stage I-disease (pT2) it was 93%, for those with stage II-disease 87% and in case of stage III-disease 47%. Conclusion: Only a few of our patients profited from ELND, namely the 6 patients suffering from pT3- or pT4-melanoma, in those clinically obvious metastases were detected and ELND had been performed and long term survival could be achieved. We regard this limited efficacy as an argument that ELND should be displaced by the Sentinel lymph node biopsy.