Complications of sentinel lymph node biopsy for melanoma - A systematic review of the literature

Purpose: The complications reported after sentinel lymph node biopsy (SLNB) for melanoma is highly variable in the worldwide literature; the overall complication rate varies between 1.8% and 29.9%. With heterogeneous reporting of morbidity data, no 'average' complication rates of this procedure have been reported. This systematic review aims to determine the complications rates associated with SLNB.

Methods: A systematic review of English-language literature from 2000 to 2015, which reported morbidity information about SLNB for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of specific post-operative complications were constructed using a random effects statistical model, and subgroups including lymph node basin and continent of origin of the study were compared.

Results: After application of inclusion and exclusion criteria, 21 articles progressed to the final analysis. 9047 patients were included. The overall complication rate was 11.3% (95% CI: 8.1-15.0). The incidence of infection was 2.9% (95% CI 1.5-4.6); seroma 5.1% (95% CI: 2.5-8.6); haematoma 0.5% (95% CI: 0.3-0.9) lymphoedema 1.3% (95% CI: 0.5-2.6) and nerve injury 0.3% (95% CI: 0.1-0.6). There was no statistically significant difference in morbidity between the sites of SLNB or between continents.

Discussion: This study provides information about the incidence of complications after SLNB. It can be used to counsel patients about the procedure and it sets a benchmark against which surgeons can audit their practice.