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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 34: ALND: 1/447
SLND: 0/453
Lymphoedema a:
Any: ALND: 59/447
SLND: 15/453
Grade 34: ALND: 3/447
SLND: 0/453
Motor neuropathy a:
Any: ALND: 37/447
SLND: 13/453
Grade 34: 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 foundg Not reported
  1. ALND axillary lymph node dissection, SLND sentinel lymph node dissection, aRT axillary radiotherapy
  2. 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
  3. bLympheoedema (objective): 2 cm or greater post-operative increase in the ipsilateral arm circumference (assessed by phycisian)
  4. cLympheoedema (subjective): according to patient self-report or physician diagnosis
  5. dAny clinical sign of lymphoedema
  6. 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
  7. 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
  8. 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