Surgical Complications Associated With Sentinel Lymph Node Dissection (SLND) Plus Axillary Lymph Node Dissection Compared With SLND Alone in the American College of Surgeons Oncology Group Trial Z0011

Lucci, Anthony; McCall, Linda; Beitsch, Peter D.; Whitworth, Patrick; Reintgen, Douglas S.; Blumencranz, Peter W.; Leitch, A. Marilyn; Saha, Satabdi; Hunt, Kelly K.; Giuliano, Armando E.

doi:10.1200/jco.2006.07.4062

Cited by 774 publications

(466 citation statements)

References 30 publications

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“…56 Over the past decade, less invasive surgical techniques such as sentinel lymph node biopsy and breast-conserving surgery have reduced the overall incidence of lymphedema; however, conservative estimates for incidence after sentinel lymph node biopsy are still in the range of 7%. 57,58 For high-risk patients treated with adjuvant radiation to a dissected axilla, the risk of subsequent lymphedema is greatly increased, with reported rates close to 45%. 7 Other breast cancer-related lymphedema risk factors for which data were not available in this systematic review of nonbreast cancer lymphedema studies include patient age, obesity, tumor factors, lymph node status, the presence of postoperative seroma or infection, and the presence of venous obstruction.…”

Section: Discussionmentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

170

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BACKGROUND: Secondary lymphedema is a debilitating, chronic, progressive condition that commonly occurs after the treatment of breast cancer. The purpose of the current study was to perform a systematic review and meta-analysis of the oncology-related literature excluding breast cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various malignancies. METHODS: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane Library databases, and Scopus) to identify studies that included a prospective assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy, and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence, and followup interval. A quality assessment of individual studies was performed using established criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary estimates when sufficient data were available. RESULTS: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n ¼ 15), gynecologic malignancies (n ¼ 22), genitourinary cancers (n ¼ 8), head/neck cancers (n ¼ 1), and sarcomas (n ¼ 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary, 10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods and longer follow-up were both associated with increased lymphedema incidence. CONCLUSIONS: Lymphedema is a common condition affecting cancer survivors with various malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010;116:5138-49.

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Section: Discussionmentioning

confidence: 99%

Lymphedema beyond breast cancer

Cormier

Askew

Mungovan

et al. 2010

Cancer

413

170

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“…Seven trials were thus eligible, as shown in Table 1 [3,4,[7][8][9][10][11]. A total of 9,608 patients were randomly assigned to treatment (658 in the SNB only arm, 5,084 in the ALND only arm and 4,406 who had SNB and then went onto have ALND), and data was available for analysis from 8,853 of them (636, 4,389 and 3,828 in the three arms, respectively).…”

Section: Eligible Studiesmentioning

confidence: 99%

“…There was little variability among studies in the menopausal status, eligible stages of breast cancer and tumour size of participants. All seven trials enroled patients between 1998 and 2005, and six of the seven studies were multicentre trials [4,[7][8][9][10][11].…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Five trials [3,4,7,9,11] described the method of power calculation, six trials [4,[7][8][9][10][11] described in detail the mode of randomization and five trials [4,[7][8][9]11] described the mode of allocation concealment in detail. Withdrawals were described in detail in six trials [3,4,[8][9][10][11].…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Withdrawals were described in detail in six trials [3,4,[8][9][10][11]. None of the seven studies were blinded.…”

Section: Eligible Studiesmentioning

confidence: 99%

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Outcome of axillary staging in early breast cancer: a meta-analysis

Kell

Burke

Barry

et al. 2010

Breast Cancer Res Treat

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Axillary lymph node dissection (ALND) is associated with significant morbidity, whilst sentinel node biopsy (SNB) has the potential to minimize complications in the management of breast cancer. The aim of this study was to systematically appraise the outcome of SNB when compared to ALND. A comprehensive search for published trials examining outcomes after SNB for breast cancer was performed using medline and cross-referencing available data. Each study was reviewed and data extracted. Primary outcomes were nodal positivity and surgery-related morbidity. A total of 9,608 patients were identified from trials comparing ALND and SNB. The overall rate of axillary lymph node positivity for those with no clinically palpable nodes was 28.8% for ALND and 27.6% for SNB (OR = 1.00, 95% CI = 0.86-1.17, P = 0.956), though there was a trend for superior detection of metastatic disease with SNB when this was compared with ALND alone (OR = 1.22, 95% CI = 0.95-1.57, P = 0.122). Patients who undergo SNB are significantly less likely to suffer post-operative morbidity relative to ALND: risk of infection (OR = 0.58, 95% CI = 0.42-0.80, P = 0.0011), seroma (OR = 0.40, 95% CI = 0.31-0.51, P = 0.0071), arm swelling (OR = 0.30, 95% CI = 0.14-0.66, P = 0.0028) and numbness (OR = 0.25, 95% CI = 0.1-0.59, P = 0.0018).SNB is at least equivalent to ALND in detecting metastatic disease in the axilla. SNB is the optimum approach in terms of morbidity for the assessment of axillary metastasis in clinically node negative breast cancer.

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