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This systematic review and meta-analysis evaluated survival and recurrence rate in these patients who underwent CLND, compared with observation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive MEDLINE and Embase database search was performed for cohort studies and RCTs published between January 2000 and June 2017 that assessed the outcomes of CLND compared with observation in patients with SLN-positive melanoma. The primary outcome was survival and the secondary outcome was recurrence rate. Studies were assessed for quality using the Cochrane risk-of-bias tool for RCTs and Newcastle\u2013Ottawa Scale for cohort studies. Pooled relative risk or hazard ratio with 95 per cent confidence intervals were calculated for each outcome. The extent of heterogeneity between studies was assessed with the I2 test. The protocol was registered in PROSPERO (CRD42017070152).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen studies (13 cohort studies with 7868 patients and 2 RCTs with 2228 patients) were identified for qualitative synthesis. Thirteen studies remained for quantitative meta-analysis. Survival was similar in patients who underwent CLND and those who were observed (risk ratio (RR) for death 0\u00b785, 95 per cent c.i. 0\u00b771 to 1\u00b702). The recurrence rate was also similar (RR 0\u00b791, 0\u00b779 to 1\u00b705).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with SLN-positive melanoma do not have a significant benefit in survival or recurrence rate if they undergo CLND rather than observation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.11149","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T12:03:59Z","timestamp":1553601839000},"page":"672-681","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Meta-analysis of completion lymph node dissection in sentinel lymph node-positive melanoma"],"prefix":"10.1093","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6500-9589","authenticated-orcid":false,"given":"C V","family":"Angeles","sequence":"first","affiliation":[{"name":"Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Shirai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S L","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"2021011409044054400_bjs11149-bib-0001","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1056\/NEJMoa1310460","article-title":"Final trial report of sentinel-node biopsy versus nodal observation in melanoma","volume":"370","author":"Morton","year":"2014","journal-title":"N Engl J Med"},{"key":"2021011409044054400_bjs11149-bib-0002","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jamcollsurg.2005.03.029","article-title":"Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma","volume":"201","author":"Sabel","year":"2005","journal-title":"J Am Coll Surg"},{"key":"2021011409044054400_bjs11149-bib-0003","doi-asserted-by":"crossref","first-page":"3677","DOI":"10.1200\/JCO.2004.01.012","article-title":"Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma","volume":"22","author":"Lee","year":"2004","journal-title":"J Clin Oncol"},{"key":"2021011409044054400_bjs11149-bib-0004","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/01.sla.0000181092.50141.fa","article-title":"Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial","volume":"242","author":"Morton","year":"2005","journal-title":"Ann Surg"},{"key":"2021011409044054400_bjs11149-bib-0005","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1245\/s10434-008-9885-2","article-title":"Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States","volume":"15","author":"Bilimoria","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"2021011409044054400_bjs11149-bib-0006","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1613210","article-title":"Completion dissection or observation for sentinel-node metastasis in melanoma","volume":"376","author":"Faries","year":"2017","journal-title":"N Engl J Med"},{"key":"2021011409044054400_bjs11149-bib-0007","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1470-2045(16)00141-8","article-title":"Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial","volume":"17","author":"Leiter","year":"2016","journal-title":"Lancet Oncol"},{"key":"2021011409044054400_bjs11149-bib-0008","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1056\/NEJMms1604593","article-title":"Assessing the gold standard \u2013 lessons from the history of RCTs","volume":"374","author":"Bothwell","year":"2016","journal-title":"N Engl J Med"},{"key":"2021011409044054400_bjs11149-bib-0009","author":"PROSPERO International Prospective Register of Systematic Reviews","year":"2017","journal-title":"Complete Lymph Node Dissection vs. Observation of Sentinel Lymph Node-positive Melanoma Patients"},{"key":"2021011409044054400_bjs11149-bib-0010","author":"JPT","year":"2008","journal-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. 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