Axillary Surgery in Sentinel Node-Positive Breast Cancer After Neoadjuvant Therapy: A Systematic Review and Meta-analysis.
Rim El Annan, Mohamad El-Jammal, Youssef H Zeidan
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In 30 seconds
This systematic review and meta-analysis evaluated the outcomes of axillary lymph node dissection (ALND) versus omission of ALND in patients with sentinel node-positive breast cancer after neoadjuvant therapy. Analyzing five studies with 4670 patients, the results indicated no significant difference in axillary recurrence rates (pooled RR 1.09, 95% CI, 0.47-2.52; P = .80) between the two approaches, suggesting that omission may be a viable option in selected patients receiving regional nodal irradiation.
Key findings
- Axillary recurrence rates were low, ranging from 0.37% to 5.7% without ALND.
- Meta-analysis showed no significant difference in axillary recurrence between omission and completion of ALND (pooled RR 1.09).
- Moderate heterogeneity was observed in the meta-analysis (I² = 46%).
- Omission of ALND may reduce surgical morbidity in selected ypN+ patients.
Why it matters
Understanding the implications of axillary surgery in breast cancer management is crucial, especially as treatment paradigms evolve. This study provides evidence that may influence surgical decision-making and patient outcomes in the context of neoadjuvant therapy and regional nodal irradiation.