Does It Really Pay-Off? Comparison of Lymphadenectomy versus Observational Approach in Skin Melanoma with Positive Sentinel Node Biopsy: Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to answer the question as to whether performing CLND (complete lymph node dissection) is necessary in every case of the melanoma patient after the positive SNB (sentinel node biopsy). To resolve doubts the authors reanalyzed previous articles and systematized the knowledge about the concerning medical problem. The databases such as PubMed, Scopus and Web of Science were screened to find articles that will be helpful to answer the controversial question if performing lymphadenectomy is crucial. The inclusion criteria consisted of randomized clinical trials, comparison of lymphadenectomy versus observation and positive sentinel node biopsy. After which, seven articles were examined. Authors analyzed parameters such as: recurrence, 3-year survival and 5-year survival. There was no relationship between the performance of CLND and melanoma recurrence (OR 1.04; 95% CI: 0.82-1.31; p = 0.75). However, no CLND group had higher 3-year survival (OR 1.22; 95% CI: 1.03-1.44; p = 0.02) and 5-year survival (OR 1.30; 95% CI: 1.19-1.85; p = 0.008). In conclusion, the observational approach to the melanoma patients with positive sentinel node biopsy is associated with comparable or slightly improved 3- and 5-year survival, then in case of routine lymphadenectomy. Although, in each melanoma patient a decision to perform or withhold lymphadenectomy should always be considered individually. Patients with low perioperative risk could be considered for surgical approach. The study was registered in PROSPERO and was assigned with the unique identifying number "CRD42021241272".