CADONOT: Comparing axillary dissection or not in breast cancer surgery

Area of Science:

• Oncology
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Sentinel lymph node biopsy (SLNB) is standard for early breast cancer axillary staging.
• Prior studies suggest SLNB alone or with radiotherapy is non-inferior to axillary dissection.
• Limited data exists comparing SLNB outcomes directly with axillary lymph node dissection (ALND) in specific patient cohorts.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials comparing SLNB versus ALND in early breast cancer.
• To evaluate oncologic outcomes (Overall Survival, Disease-Free Survival, recurrence) and patient-reported morbidity (lymphedema).
• To determine the safety and efficacy of SLNB as an alternative to ALND for patients with 1-2 positive sentinel nodes.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines, registered at PROSPERO.
• Inclusion of randomized controlled trials published between 2010-2024 from Medline, Embase, and Cochrane databases.
• Analysis of 5-, 8-, and 10-year Overall Survival, Disease-Free Survival, recurrence rates, and lymphedema incidence using R software, with bias and quality assessment (Cochrane RoB, GRADE).

Main Results:

• Seven randomized controlled trials involving 7338 women were analyzed, with follow-up up to 10 years.
• SLNB demonstrated a 65% lower risk of lymphedema compared to ALND.
• No significant differences were observed in 5-, 8-, or 10-year Overall Survival, Disease-Free Survival, or recurrence rates between SLNB and ALND.

Conclusions:

• SLNB is a safe and effective alternative to ALND for early-stage breast cancer with 1-2 positive sentinel lymph nodes.
• SLNB provides comparable oncologic outcomes to ALND with a significantly lower risk of lymphedema.
• The findings support de-escalation of axillary surgery, reducing patient morbidity without compromising cancer control.