Long-Term Shoulder Dysfunction After Breast and Axillary Surgery: Impact of Surgical Extent and Predictors of Function.

PURPOSE: To evaluate long-term shoulder outcomes after sentinel lymph-node biopsy (SLNB) versus axillary lymph-node dissection (ALND) and identify predictors of chronic shoulder dysfunction.

MATERIAL AND

METHODS

This prospective multicenter study enrolled 1111 women (≥ 18 years) undergoing breast cancer surgery with SLNB (n = 931) or ALND (n = 180) across five tertiary hospitals between October 2022 and June 2024. Functional outcomes were assessed using QuickDASH, range-of-motion (ROM), daily-activity limitations, pain, axillary web syndrome (AWS), and lymphedema. Multivariable regression identified independent predictors of poor shoulder function.

RESULTS

ALND was associated with consistently greater morbidity. Mean QuickDASH scores were 17.1 ± 10.5 after ALND versus 11.5 ± 9.8 after SLNB (p < 0.001). ROM limitation (38.3% vs. 20.0%), reduced daily-activity performance (41.1% vs. 23.1%), AWS (13.9% vs. 7.0%), and lymphedema (16.1% vs. 4.2%) were all more frequent after ALND (p ≤ 0.002). Pain intensity was higher (2.28 ± 2.82 vs. 1.31 ± 2.11; p < 0.001). In multivariable analysis, ALND (β = 1.18, p < 0.001), higher BMI (β = 0.27, p = 0.001), and depressive disorders (β = 0.31, p < 0.001) independently predicted worse shoulder function; age and physiotherapy timing were not significant. Functional deficits persisted across lumpectomy and mastectomy subgroups.

CONCLUSIONS

ALND is associated with greater long-term shoulder dysfunction compared with SLNB. Obesity and depressive symptoms exacerbate morbidity, highlighting the importance of comprehensive survivorship rehabilitation.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05950685.