Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Quality measures in cervical lymphadenectomy for cutaneous malignancy, eleven years of experience  (1216)

Fouad Nahab 1 2 , Sita Ollek 3 , Richard Harman 2 , Richard Martin 2
  1. Plastic, Reconstructive and Hand Surgery, Middlemore Hospital, Auckland, New Zealand
  2. General Surgery, North Shore Hospital, WDHB, Auckland, New Zealand
  3. Surgical Oncology, University of British Columbia, Vancouver, Canada

Background:

Therapeutic lymphadenectomy remains the gold standard for surgical management of clinically evident regional cervical disease for cutaneous malignancy. However, international consensus on adequate lymphadenectomy is lacking. With attempts to establish quality measures, high volume centres have suggested benchmarks for minimum and average nodal yield, as well as recurrence and complication rates1. We aimed to compare our key performance indicators to those benchmarks published in the literature.

Methods:

We conducted a retrospective observational study using prospectively maintained data, from a Waitemata District Health Board and the Melanoma Unit over an eleven year period (2007-2018). Data for Melano ma and Cutaneous Squamous Cell carcinoma (cSCC) were analysed separately.

Results:

91 cervical lymphadenectomies performed for cutaneous malignancies were included. Mean nodal yield for ≤3 and ≥4 dissection levels were 19.7 and 38.7 nodes respectively. Overall combined local and regional recurrence rate of 25%, with subgroup analysis for melanoma group (60) and SCC group (28) revealing regional nodal recurrence of 15% and 11%, respectively. We observed a 38.5% complication rate; however less than 5.5% was considered grade IIIb/IIIb(d) [Clavein-Dindo]. Median follow-up of 19.3 months, 5 year survival rate of 38% for melanoma and 32% for cSCC .

Conclusion:

Our centre provides head and neck oncological resection services to the largest District Health Board in the country. Our data indicates that we are meeting quality measures, as suggested by high volume centres1,2. We believe that any surgeon with subspecialty training in head and neck surgery can meet quality measures with regards to cervical lymphadenopathy for cutaneous malignancy.

  1. 1. Spillane AJ, Bernard LH, Cheung BM, Stretch JR, DP, Scolyer RA. Proposed quality standards for regional lymph node dissection in patients with Melanoma. Annals of Surgery, 2009. 249(3), 473-480.
  2. 2. Rossi CR, Mozzillo N, Maurichi A, Pasquali S, Quaglino P, Borgognoni L, et al. The number of excised lymph nodes is associated with survival of melanoma patients with lymph node metastasis. Annals of Oncology, 2014: 25, 240-246.
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