Journal Review in Surgical Oncology: Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 8 September 2022

⏱️ 16 minutes

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Summary

What is the value of completion lymph node dissection for patients with melanoma with sentinel-node metastases?

The Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) confirmed that SLNB is an important part in the treatment of patients with melanoma, but what needed to be done beyond that in managing the axilla?

Learning Objectives:
In this episode, we review perioperative chemotherapy regimens for locally advanced, resectable Gastric cancer, standard of care, and the future role for immunotherapy.

Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program.

Caitlin Hester, MD (@CaitlinAHester) is a new Assistant Professor of Surgery at the University of Miami

Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research.

Papers Referenced in this Episode:

Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma
Morton et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1310460

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma
Faries et al.
https://www.nejm.org/doi/full/10.1056/nejmoa1613210

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out our Journal Review Series here: https://behindtheknife.org/podcast-series/journal-review/

Transcript

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0:00.0	Behind the Knife, the Surgery Podcast, relevant and engaging content designed to help you
0:12.0	dominate the day.
0:14.0	Hello, we'd like to welcome you to another episode of Behind the Knife Podcast for
0:27.6	surgical oncology. My name is Adam Yoke. I'm one of the surgical oncologists at UT Southwestern
0:32.2	in Dallas. I have a pleasure to be joined by two up and coming surgical oncologists, Dr.
0:39.5	Gilbert Marimoa, who's a research resident at UT Southwestern in his PGY five year right
0:48.2	now. And Dr. Caitlin Hester, who will be a new faculty member at the University of Miami as an
0:55.4	associate assistant professor of surgery at the University of Miami, the division of surgical
1:00.2	oncologists, so welcome to you both. So today we're going to review the practice changing MSL T2
1:07.9	trial. The multi-center selective lymphatic anatomy trials are quite monumental in the management of
1:14.1	how we treat patients and how we care for patients with melanoma. They're really high level and I
1:20.1	think everybody will agree high impact research and should serve as an example how clinical trials
1:25.9	in the United States with multi-institution should really be conducted. Prior to delving right
1:31.9	into the second MSLT trial, I think it's probably important that we really lay the framework
1:38.8	by outlining the first MSLT trial. So Caitlin, really what was the aim of the first MSLT trial?
1:45.2	This trial really aimed to determine if sentinel node biopsy could be used to identify
1:50.6	patients with clinically occult nodal metastases and whether immediate completion lymphadenectomy
1:57.6	among those who were who did have positive sentinel lymph nodes yielded improved outcomes compared
2:04.9	to nodal observation without sentinel lymph node biopsy. Gilbert, what patient's story is important
2:11.6	when we talk about clinical trials about the applicability to the greater population at large
2:18.1	and really it's what patients were included in this study and who was excluded more importantly.
2:25.0	So any patient with primary and cutaneous melanomas greater than one millimeter in thickness
	...

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