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. 2024 Aug;31(8):5324-5330.
doi: 10.1245/s10434-024-15274-0. Epub 2024 May 18.

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

Lisanne P Zijlker  1   2   3 , Henry Chen  4 , Andrew J Spillane  3   4   5   6 , Maria Gonzalez  3 , Thomas E Pennington  3   4   7 , Alexander M Menzies  3   4   5   6 , Serigne N Lo  3   4 , Peter Ferguson  3   4   7   8 , Robert Rawson  3   4   7   8 , Andrew J Colebatch  3   4   7   8 , Jonathan R Stretch  3   4   7 , John F Thompson  3   4   6   7 , Sydney Ch'ng  3   4   7 , Omgo Nieweg  3   4   7 , Kerwin F Shannon  3   4   7 , Georgina V Long  3   4   5   6 , Richard A Scolyer  3   4   7   8   9 , Robyn P M Saw  3   4   7 , Alexander C J van Akkooi  10   11   12
Affiliations

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

Lisanne P Zijlker et al. Ann Surg Oncol. 2024 Aug.

Abstract

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.

Keywords: Complications; Melanoma; Neoadjuvant; Surgery; Systemic therapy; Textbook outcomes.

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Conflict of interest statement

Alexander M. Menzies has served on an advisory board for BMS, MSD, Novartis, Roche, Pierre-Fabre, and QBiotics. John F. Thompson has received honoraria for advisory board participation from BMS Australia, MSD Australia, GSK, and Provectus Biopharmaceuticals Inc, and travel and conference support from GSK, Provectus Inc, and Novartis. Richard A. Scolyer has received fees for professional services from MetaOptima Technology Inc., F. Hoffmann-La Roche Ltd, Evaxion, Provectus Biopharmaceuticals Australia, Qbiotics, Novartis, Merck Sharp & Dohme, NeraCare, AMGEN Inc., Bristol-Myers Squibb, Myriad Genetics, and GlaxoSmithKline. Robyn P. M. Sawhas received honoraria for advisory board participation from MSD, Novartis, and Qbiotics, and speaking honoraria from BMS and Novartis. Robert V. Rawson has received honoraria for speaking and advisory board participation from Merck Sharp & Dohme. Georgina V. Long is consultant advisor for Agenus, Amgen, Array Biopharma, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Evaxion, Hexal AG (Sandoz Company), Highlight Therapeutics S.L., Innovent Biologics USA, Merck Sharpe & Dohme, Novartis, PHMR Ltd, Pierre Fabre, Provectus, Qbiotics, and Regeneron. Alexander C. J. van Akkooi declares advisory board and consultancy honoraria at Amgen, Bristol-Myers Squibb, MSD-Merck, Merck-Pfizer, Neracare, Novartis, Pierre Fabre, Sanofi, and Sirius Medical, 4SC, and research grants from Amgen and Merck-Pfizer. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
A Rate of complications. B Postoperative seroma. C Postoperative lymphedema. D Rate of patients achieving no read (no readmission), no reop (no reoperation), R0 (R0 resection), no compl (no Clavien–Dindo grade >2 complications), or TO (textbook outcome).
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