Effect of sentinel lymph node biopsy on upper limb function in women with early breast cancer: A systematic review of clinical trials

Abstract

Purpose: Axillary surgery is still essential in the management of early breast cancer. Conservative procedures like sentinel lymph node biopsy (SLNB) are less invasive than the traditional axillary node dissection (ALND). However, some extent of ipsilateral upper limb dysfunction might still occur. This systematic review aimed to describe the incidence of lymphedema, pain, sensory, and motor disorders after SLNB in women with early breast cancer.

Methods: We conducted a systematic review of randomized controlled trials. The search was performed on Pubmed, EMBASE, CINAHAL, and Web of Science. The search was based on the following concepts: breast cancer, sentinel lymph node biopsy, axillary dissection, upper limb complications. The risk of bias was evaluated using the Cochrane Rob 2.0 toll.

Results: We obtained 979 unique registries from the primary search and 381 additional records from the included articles' reference lists. Fifty-one articles were assessed as full text. Nine studies were included in the review. A total of 5161 patients undergone SLNB, and 4110 patients were assessed for ipsilateral arm complications. Six months after the surgery, 0-11% of patients presented lymphedema, 11-16% pain, 2-22% sensory disorders, and 0-9% motor disorders.

Conclusions: SLNB was associated with persistent postoperative complications. The burden of complications, although lower when compared to ALND, should not be ignored.

Protocol registration: PROSPERO registration number CRD42018090540, registered July 09, 2018.

Keywords: Axillary dissection; Breast cancer; Randomized clinical trials; Sentinel lymph node biopsy; Upper limb complications systematic review.