Impact of lymphadenectomy on axillary recurrence and morbidity of the upper limb in breast cancer patients with negative sentinel node. A prospective randomised study

Fougo, José Luís; Dinis‐Ribeiro, Mário; Araújo, Cláudia; Dias, Teresa; Reis, Paulo; Giesteira, L.; Castro, Fernando; Silva, Hernâni

doi:10.1016/s2173-5077(11)70039-4

Cited by 5 publications

(7 citation statements)

References 47 publications

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“…2a),3,4,6,11–23 12 to 24 months (Fig. 2b),4,6,11–13,16,22,24–28 and more than 24 months (Fig. 2c)3,4,10–12,29–46 was observed to be 16.5% (16 studies, n=3515, 95% CI: 11–22, I 2 = 97.1%, P <0.0005), 24.6% (12 studies, n=1971; 95% CI: 11–38, I 2 = 98.3%, P <0.0005) and 23.6% (23 studies, n=5288; 95% CI: 16.4–30.9, I 2 = 98.3%, P <0.0005), respectively.…”

Section: Resultsmentioning

confidence: 91%

“…Among 38 studies that reported the prevalence of lymphedema at different time intervals, the pooled estimate for the prevalence of lymphedema after ALND at <12 months (Fig. 2a), 3,4,6,[11][12][13][14][15][16][17][18][19][20][21][22][23] 12 to 24 months (Fig. 2b), 4,6,[11][12][13]16,22,[24][25][26][27][28] and more than 24 months (Fig.…”

Section: Rates Of Lymphedema After Alnd and Slnbmentioning

confidence: 99%

“…2a), 3,4,6,[11][12][13][14][15][16][17][18][19][20][21][22][23] 12 to 24 months (Fig. 2b), 4,6,[11][12][13]16,22,[24][25][26][27][28] and more than 24 months (Fig. 2c) 3,4,[10][11][12][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][4...…”

Section: Rates Of Lymphedema After Alnd and Slnbunclassified

“…3a), 12,16,20,[55][56][57] between 12 and 24 months (Fig. 3b), 12,26,36,55,58 and beyond 24 months (Fig. 3c) 12,16,24,40,46,59 was 40% (6 studies, n = 1335; 95% CI: 23.8-56.2, I 2 = 97.8%, P < 0.0005), 38.5% (5 studies, n = 540; 95% CI: 15.7-61.4, I 2 = 96.2%, P < 0.0005), and 32.9% (6 studies, n = 426; 95% CI: 18.8-47, I 2 = 90.9%, P < 0.0005), respectively.…”

Section: Slnb and Alndmentioning

confidence: 99%

“…2b), 4,6,[11][12][13]16,22,[24][25][26][27][28] and more than 24 months (Fig. 2c) 3,4,[10][11][12][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] was observed to be 16.5% (16 studies, n = 3515, 95% CI: 11-22, I 2 = 97.1%, P < 0.0005), 24.6% (12 studies, n = 1971; 95% CI: 11-38, I 2 = 98.3%, P < 0.0005) and 23.6% (23 studies, n = 5288; 95% CI: 16.4-30.9, I 2 = 98.3%, P < 0.0005), respectively.…”

Section: Rates Of Lymphedema After Alnd and Slnbmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 91%

Section: Rates Of Lymphedema After Alnd and Slnbmentioning

confidence: 99%

Section: Rates Of Lymphedema After Alnd and Slnbunclassified

Section: Slnb and Alndmentioning

confidence: 99%

Section: Rates Of Lymphedema After Alnd and Slnbmentioning

confidence: 99%

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

et al. 2022

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Long-term Outcome of Patients Managed With Sentinel Lymph Node Biopsy Alone for Node-Negative Invasive Breast Cancer

Kapoor¹,

Sim²,

Giuliano³

2012

Arch Surg

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To examine the long-term outcome of patients with early breast cancer with hematoxylin-eosinnegative sentinel lymph nodes (SLNs) who did not undergo completion axillary lymph node dissection. Design, Setting, and Patients: Patients with invasive breast cancer surgically treated between May 1, 1995, and December 31, 2002, with SLN biopsy alone without axillary lymph node dissection who had hematoxylineosin-negative SLNs were identified. Main Outcome Measures: Patient and tumor characteristics, adjuvant treatment, disease recurrence, and survival were recorded. A multivariable analysis model was used to identify significant variables associated with disease-free survival and overall survival. Results: A total of 811 patients were included, with a median follow-up of 103.1 months (range, 12.2-182.8 months). The mean patient age was 57.8 years (range, 26-91 years), the mean tumor size was 1.5 cm (range, 0.1-7.5 cm), and the median number of SLNs obtained was 2 (range, 1-8). Seventy-six patients (9.4%) developed disease recurrence; there were 2 patients (0.2%) with isolated axillary recurrences, 40 (4.9%) with local recurrences, 4 (0.5%) with local and regional recurrences, 22 (2.7%) with distant recurrences, and 8 (1.0%) with both local and distant recurrences. The median time to recurrence was 57.2 months (range, 3.1-163.3 months), with 5-year and 10-year disease-free survival rates of 95.1% and 89.9%, respectively. One hundred one patients (12.5%) died; only 15 (1.8%) had distant metastatic disease at the time of death. Patients were significantly more likely to have disease recurrence if they had high-grade tumors (P=.004). Older age and larger tumor size were significant predictors of worse overall survival on multivariate analysis (PϽ .001 and P =.01, respectively). Conclusions: This study reports the long-term follow-up of patients with breast cancer and hematoxylineosin-negative, tumor-free SLNs, showing a remarkably low axillary recurrence of 0.2% and high disease-free survival. Long-term results of SLN biopsy alone are excellent, and the addition of immunohistochemistry analysis does not contribute to survival.

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Axillary treatment for operable primary breast cancer

Bromham

Schmidt‐Hansen

Astin

et al. 2017

Cochrane Database of Systematic Reviews

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Impact of lymphadenectomy on axillary recurrence and morbidity of the upper limb in breast cancer patients with negative sentinel node. A prospective randomised study

Cited by 5 publications

References 47 publications

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

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

Long-term Outcome of Patients Managed With Sentinel Lymph Node Biopsy Alone for Node-Negative Invasive Breast Cancer

Axillary treatment for operable primary breast cancer

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