Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients

Abstract

Objective: To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients. Background: Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for deescalation strategies. Methods: Embase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed. Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5-16.8, P < 0.005) and 24.2% (95% confidence interval: 12.1-36.3, P < 0.005), respectively. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities. Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated. ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. The findings support the continued drive to de-escalate axillary surgery.

Advantage of contrast-enhanced ultrasound guided sentinel lymph node biopsy in early-stage breast cancer, one node might be enough: a prospective cohort study.

“…[24] Retrospective studies and meta-analyses have demonstrated that there is still a certain morbidity of upper limb complications after SLNB surgery, the most common is axillary pain, which torments more than 10 percent of patients. [25][26][27] The reason may be largely due to excessive exploration of SLN. Previous study has suggested that, in a small minority of patients, the SLN for the breast and upper limb may be at the same station.…”

Assessing the preventive effect of immediate lymphatic reconstruction on the upper extremity lymphedema

“…Rockson et al reported that the presence of hypertension in 51 of 130 patients seemed to predispose the development of lymphedema (P<0.005) (26). Several studies also reported that axillary radiotherapy increase the risk of lymphedema from 1.91-to 4.285-fold (19,27,28).…”

Spotlight in Plastic Surgery: October 2023

“…2023;277:572-580. 6 This study investigates the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy on upper extremity morbidity in patients with breast cancer. Included studies were objective-based, using validated tools for lymphedema, range of motion, and strength.…”