The role of elective lymph node dissection in XXXX : rationale, results, and controversies.

@entity1 @entity5 @entity1066 @entity3 @entity320
Elective lymph node dissection (ELND) for @entity1 with clinically occult metastatic @entity320 in regional lymph nodes has the goal of curing @entity3 with a surgical treatment. This is in contrast to the low probability for surgical cure in @entity1 with clinically detectable lymph node @entity3 . The rationale for elective node dissection is based on a hypothesis that @entity320 metastasizes sequentially via lymph nodes and then to distant sites. A subgroup of @entity320 @entity1 with high risk for regional node micrometastases but low risk for distant micrometastases has been identified from prognostic factors analysis of large @entity1 series, as well as surgical results of nonrandomized clinical trials. However, two nonrandomized surgical trials have failed to show a survival benefit for ELND. These studies were largely performed in female @entity1 with extremity @entity320 and there were limitations that preclude a definitive conclusion. No randomized trials have been conducted involving @entity320 of the trunk or head and neck. Two prospective randomized surgical trials are now being conducted in North America and in Europe. Until the results of these trials are available, physicians are encouraged to enter @entity1 into these ongoing clinical trials or consider ELND in selected @entity1 where the benefit-risk ratio justifies it. Factors to be considered in this decision include intermediate @entity5 thickness (ie, 1 to 4 mm thickness), anatomic site, histology ( @entity1066 and growth pattern), and the risk of the operation in individual @entity1 settings.
