Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: A systematic review and meta-analysis

• Published in: European journal of cancer (1990) Vol. 49; no. 4; pp. 812 - 825
• Main Authors: Glechner, Anna, Wöckel, Achim, Gartlehner, Gerald, Thaler, Kylie, Strobelberger, Michaela, Griebler, Ursula, Kreienberg, Rolf
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.03.2013; Elsevier
• Subjects: Axilla; Axilla/surgery; Biological and medical sciences; Breast neoplasms; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Disease-free survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision; Lymphatic Metastasis; Medical sciences; Meta-analysis; Meta-Analysis as Topic; Neoplasm Invasiveness; Neoplasm recurrence; Pharmacology. Drug treatments; Sentinel Lymph Node Biopsy; Survival analysis; Systematic review; Tumors; Survival analysis; Disease-free survival; Sentinel lymph node biopsy; Lymphatic metastasis; Systematic review; Neoplasm recurrence; Breast neoplasms; Axilla/surgery; Lymph node excision; Meta-analysis; Relapse; Breast disease; Sentinel lymph node; Breast tumor; Malignant lymphadenopathy; Metaanalysis; Lymphadenectomy; Cancerology; Surgery; Axilla; Invasive cancer; Disease free survival; Excision; Lymph node; Malignant hemopathy; Breast cancer; Malignant tumor; Lymph node metastasis; Mammary gland diseases; Anatomic pathology; Treatment; Biopsy; Axillary ganglion; Early; Comparative study; Bibliographic review; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2012.09.010

Abstract Background The Z0011-study, a landmark randomised controlled trial (RCT) challenged the benefits of complete axillary lymph node dissection (ALND) compared with sentinel lymph node dissection only (SLND) in breast cancer patients with positive sentinel nodes. The study, however, has been criticised for lack of power and low applicability. The aim of this review was to systematically assess the evidence on the comparative benefits and harms of ALND versus SLND for sentinel node positive breast cancer patients. Methods We systematically searched PubMed, Embase, the Cochrane Library, and reference lists of pertinent review articles from January 2006 to August 2011. We dually reviewed the literature and rated the risk of bias of each study. For effectiveness, we included RCTs and observational studies of at least 1 year follow-up. In addition, we considered studies conducted in sentinel node-negative women to assess the risk of harms. If data were sufficient, we conducted random effects meta-analysis of outcomes of interest. Results Meta-analysis of three studies with 50,120 patients indicated similar 5-year survival and regional recurrence rates between patients treated with ALND or SLND, although prognostic tumour characteristics varied among the 3 study-populations. Results from 6 studies on more than 11,500 patients reported a higher risk for harms for ALND than SLND. Long-term evidence on pertinent health outcomes is missing. Conclusion The available evidence indicates that for some women with early invasive breast cancer SLND appears to be a justifiable alternative to ALND. Surgeons need to discuss advantages and disadvantages of both approaches with their patients.