Axillary dissection vs. non-axillary dissection in breast cancer patients with sentinel lymph node metastasis: An updated systematic review and meta-analysis of randomized clinical trials.

OBJECTIVES

Perform an updated meta-analysis of RCTs that evaluated survival and recurrence in patients with clinically node-negative breast cancer with sentinel lymph node metastasis who underwent sentinel lymph node dissection (SLND) alone compared to axillary lymph node dissection (ALND).

METHODS

A systematic search was conducted in PubMed, Embase, and Cochrane databases for studies on clinical T1-T3, N0, M0 primary breast cancer patients with pSLN undergoing SLND or ALND. The primary outcomes of interest are disease-free survival, overall survival, and recurrence rate; surgical adverse effects and mortality rate are evaluated as secondary outcomes.

RESULTS

We included eight RCTs, in which 3952 patients underwent SLND, and 3871 underwent ALND in the presence of sentinel lymph node metastasis. We observed that overall survival and disease-free survival were non-inferior in the experimental group. When analyzing recurrence rates, axillary recurrence was the only type for which ALND appeared to have a protective effect. In contrast, local and distal recurrence were more common in the group undergoing complete axillary dissection. In terms of morbidity, patients who underwent SLND alone had fewer adverse surgical effects. The reduction in lymphedema was statistically significant only at the 5-year endpoint after randomization. However, the occurrence was lower in the experimental group at all time points analyzed in the studies.

CONCLUSION

Our findings show that SLND reduces surgical complications associated with ALND and improves quality of life without decreasing local control and overall survival in patients with T1-T2/T3 breast cancer with clinically negative nodes and the presence of 1-2 pSLN.