Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses

Schmidt-Hansen, Mia; Bromham, Nathan; Hasler, Elise; Reed, Malcolm W.

doi:10.1186/s40064-016-1712-9

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Table 3 Morbidity outcomes in the included studies

From: Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses

Comparison	SLND + ALND versus SLND alone			ALND versus aRT
Study	ATTRM-048-13-2000	IBCSG-23-01	ACOSOG Z0011	AMAROS	OTOASOR
Short-term adverse events	Not reported	Post-operative infection: ALND: 1/464 SLND: 0/467	Wound infection: ALND: 31/373 SLND: 11/371; Axillary seromas: ALND: 53/373 SLND: 21/371; Axillary paresthesias: ALND: 174/373 SLND: 43/371; Objective lymphodema ^b: ALND: 23/255 SLND: 17/272	Not reported	Not reported
Long-term complications	Not reported	Sensory neuropathy ^a: Any: ALND: 82/447 SLND: 55/453 Grade 3–4: ALND: 1/447 SLND: 0/453 Lymphoedema ^a: Any: ALND: 59/447 SLND: 15/453 Grade 3–4: ALND: 3/447 SLND: 0/453 Motor neuropathy ^a: Any: ALND: 37/447 SLND: 13/453 Grade 3–4: ALND: 3/447 SLND: 1/453	Brachial plexus injury: 6 months: ALND: 5/406; SLND: 3/415; 12 months: ALND: 1/406; SLND: 0/415; Axillary paresthesias: 6 months: ALND: 146/335; SLND: 35/288; 12 months: ALND: 113/287; SLND: 24/268; Objective lymphoedema ^b: 6 months: ALND: 29/270; SLND: 21/271; 12 months: ALND: 26/242; SLND: 14/226; Subjective lymphodema ^c: 6 months: ALND: 27/327; SLND: 19/339; 12 months: ALND: 37/288; SLND: 12/268; >12 months: ALND: 52/272; SLND: 14/253	Sign of lymphoedema ^d: Baseline: ALND: 3/655; aRT: 0/586, p = 0.25; 12 months: ALND: 114/410; aRT: 62/410, p < 0.0001; 3 years: ALND: 84/373; aRT: 47/341, p = 0.003; 5 years: ALND: 76/328; aRT: 31/286, p < 0.0001; Arm circumference increase ≥ 10 % ^e: Baseline: ALND: 33/655; aRT: 24/586, p = 0.5; 12 months: ALND: 32/410; aRT: 24/410, p = 0.332; 3 years: ALND: 38/373; aRT: 22/341, p = 0.08; 5 years: ALND: 43/328; aRT: 16/286, p = 0.0009; Shoulder mobility ^f: No differences found in the range of motion in the four excursions at 1 (p = 0.29) or 5 years (p = 0.47).	Not reported
Quality of life	Not reported	Not reported	Not reported	No differences found^g	Not reported

ALND axillary lymph node dissection, SLND sentinel lymph node dissection, aRT axillary radiotherapy
^aThe treating physician assessed and reported long-term surgical events (sensory neuropathy, lymphoedema, and motor neuropathy) at every follow-up visit (every 4 months from the date of randomisation for the first year, and every 6 months for years 2–5) on the basis of the National Cancer Institute Common Toxicity Criteria version 2. No more information reported
^bLympheoedema (objective): 2 cm or greater post-operative increase in the ipsilateral arm circumference (assessed by phycisian)
^cLympheoedema (subjective): according to patient self-report or physician diagnosis
^dAny clinical sign of lymphoedema
^eArm circumference was measure 15 cm above the medial epicondyle (upper arms) and 15 cm below the medial epicondyle (lower arms). An increase in arm circumference of at least 10 % in the lower arm or the upper arm, or both, compared with the contralateral arm at the same timepoint was judged to be clinically significant lymphoedema
^fThe range of motion in both arms was measured in four excursions: abduction, adduction, anteversion, and retroversion and compared between arms. The four relative excursions were combined in a multivariate composite endpoint at 1 and 5 years
^gAssessed using the EORTC quality-of-life questionnaire (EORTC-QLQ-C30; version 3) and breast cancer module (QLQ-BR23) using the pain, body image, and arm symptoms scales. The arm symptoms scale was composed of three items: pain in arm or shoulder, swollen arm or hand, and difficulties moving arm. Questionnaires were completed at baseline and at years 1, 2, 3, 5, and 10. All outcome data at 10 years subject to a future report

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