Antonella Vecchiato1, Simone Mocellin1,2, Paolo Del Fiore3, Giulio Tosti4, Paolo A Ascierto5, Maria Teresa Corradin6, Vincenzo De Giorgi7, Giuseppe Giudice8, Paola Queirolo9, Caterina Ferreli10, Marcella Occelli11, Monica Giordano12, Giusto Trevisan13, Luigi Mascheroni14, Alessandro Testori15, Romina Spina1, Alessandra Buja16, Francesco Cavallin17, Corrado Caracò18, Antonio Sommariva19, Carlo Riccardo Rossi1,2. 1. Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy. 2. Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padova, Italy. 3. Surgical Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy. paolo.delfiore@iov.veneto.it. 4. Division of Melanoma, Sarcoma and Rare Tumors, IRCCS, European Institute of Oncology, Milan, Italy. 5. Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy. 6. Department of Dermatology, Santa Maria degli Angeli Hospital, Pordenone, Italy. 7. Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy. 8. Division of Plastic and Reconstructive Surgery and Burn Unit, University of Bari, Bari, Italy. 9. Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy. 10. Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 11. Medical Oncology Unit, Santa Croce and Carle Teaching Hospital, Cuneo, Italy. 12. Pathology, ASST-Lariana, Ospedale Sant'Anna, Como, Italy. 13. DSM-Department of Medical Sciences, University of Trieste, Trieste, Italy. 14. Unit of General Surgery, San Pio X Hospital, Milan, Italy. 15. Department of Dermatology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy. 16. Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova, Italy. 17. Independent Statistician, Solagna, Italy. 18. National Cancer Institute Fondazione G. Pascale, SC Chirurgia Melanoma e dei Tumori Cutanei, Naples, Italy. 19. Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Abstract
BACKGROUND: Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. METHODS: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. RESULTS: Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. CONCLUSIONS: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management.
BACKGROUND: Reproducible, high-quality surgery is a key point in the management of cancerpatients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. METHODS: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. RESULTS: Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. CONCLUSIONS: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management.
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