Systematic review and meta-analysis comparing perioperative outcomes of minimally invasive and open axillary lymph node dissection in breast cancer.

PURPOSE: To conduct a structured assessment comparing perioperative performance and postoperative adverse events between minimally invasive axillary lymph node dissection (MI-ALND) and traditional open ALND in breast cancer patients, with the aim of offering data-driven support for surgical decision-making in clinical practice. METHODS: We systematically queried PubMed, Web of Science, Embase, and the Cochrane Library, covering the period from database inception to November 2025 to identify English language studies comparing MI-ALND with open ALND. Statistical processing was conducted in Stata 18. Summary effects were calculated as weighted mean differences (WMDs) for continuous measures and odds ratios (ORs) for discrete outcomes. Methodological quality of the eligible studies was evaluated using the Newcastle–Ottawa Scale (NOS). RESULTS: Across the three eligible studies, a combined total of 239 individuals with breast cancer were assessed—112 underwent minimally invasive ALND and 127 received the traditional open procedure. The pooled analysis indicated that MI-ALND required more operative time (WMD = 11.72; 95% CI: 5.27,18.17; P = 0.02), and it was associated with a statistically lower estimated blood loss (WMD = − 13.27; 95% CI: −17.64 to − 8.91; P = 0.025), although the absolute difference was small. Postoperative complications showed no statistically significant difference between approaches in the pooled analysis; however, interpretation is limited by heterogeneous reporting and the small number of studies. CONCLUSION: This meta-analysis is an exploratory study and its conclusions are based solely on three small retrospective studies. MI-ALND may reduce estimated blood loss but prolong operative time, while evidence on morbidity and oncologic safety remains limited. Larger prospective studies with standardized outcomes are needed before firm conclusions can be drawn.