University of Groningen Quality of Life After Axillary or Groin Sentinel Lymph Node Biopsy, With or Without Completion Lymph Node Dissection, in Patients With Cutaneous Melanoma

Background. The aim of this study was to asses quality of life (QoL) after axillary or inguinal sentinel lymph node biopsy (SLNB) with or without completion lymph node dissection (CLND) in patients with cutaneous melanoma by comparing patients to a norm group of the general population and by comparing QoL between four patient groups depending on surgical procedure and location, i.e., patients receiving an axillary or groin SLNB, or an axillary or groin CLND. Methods. Between 1995 and 2003, a total of 242 axillary and inguinal SLNBs were performed. Of the 127 patients eligible for the study, 116 patients participated (91%). QoL was measured by the 30-item European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the McGill Pain Questionnaire and the Groningen Activity Restriction Scale. Results. Median age at diagnosis was 50 (range, 18–77) years; median Breslow thickness 2.0 (range, 1–13) mm; median follow-up 56 (range, 4–94) months. SLNB only was performed in 89 patients (77%): 48 in the groin and 41 in the axilla. CLND was performed in 27 patients (23%): 13 in the axilla and 14 in the groin. More postoperative complications (13 vs. 5; P \ 0.001) and lymphedema (10 vs. 8; P \ 0.001) occurred in the CLND group than in the SLNB group. The total group of patients reported better physical (P \ 0.001), role (P \ 0.001), emotional (P \ 0.001), and social functioning (P = 0.049), global QoL (P \ 0.001), and less fatigue (P \ 0.001) and pain (P \ 0.001) than a German norm group. Analysis of variance revealed significant differences in role functioning (P = 0.02) and tendencies toward physical problems (P = 0.051) and fatigue (P = 0.051) between the four groups. Post hoc Bonferroni tests showed that the axillary CLND group had more problems than the axillary and inguinal SLNB groups. Kruskal-Wallis tests showed that the axillary CLND group reported most pain. Conclusions. QoL in melanoma survivors after axillary or inguinal SLNB with or without CLND was better than that in a norm group. Patients who underwent CLND in the axilla after SLNB reported most problems. Cancer patients experience numerous problems in physical, emotional, social, practical, and spiritual functioning. Those who survive their disease reportedly continue to experience physical and psychosocial problems, such as functional impairment; worries about recurrence, second malignancies, or late effects of treatment; and employment, financial, or insurance problems. However, comparable or even better quality of life (QoL) has been found in cancer survivors, as well as in long-term melanoma survivors treated with isolated limb perfusion. Sentinel lymph node biopsy (SLNB) was developed by Morton et al. in the 1990s to stage patients with clinical stage I or II cutaneous melanoma. Over the years, it has proved to Presented at ESSO 2008 – 14th Congress of the European Society of Surgical Oncology, 10-12 September, The Hague, The Netherlands. The Author(s) 2009. This article is published with open access at Springerlink.com First Received: 5 October 2008; Published Online: 29 July 2009 H. J. Hoekstra, MD, PhD e-mail: h.j.hoekstra@chir.umcg. nl Ann Surg Oncol (2009) 16:2840–2847 DOI 10.1245/s10434-009-0602-6