Neuropathic Pain Prevalence After Axillary Procedures in Breast Cancer: A Systematic Review and Meta-analysis

With improved survival rates in breast cancer, managing long-term morbidity of breast cancer patients is becoming increasingly relevant. Chronic pain after breast cancer surgery affects 20% to 60% of patients, of which 30% to 68% are neuropathic in nature. However, there is an existing gap in the literature concerning the exact prevalence of neuropathic pain, specifically regarding surgical axillary procedures in breast cancer patients. This systematic review and meta-analysis aimed to investigate the prevalence of neuropathic pain after axillary procedures, including axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). The electronic bibliographic databases Embase, Medline, and Web of Science were searched from inception until February 2025. Inclusion and exclusion criteria were defined to include studies reporting on neuropathic pain prevalence following axillary procedures in breast cancer patients. Meta-analyses were performed to quantify pooled prevalences. Overall, 15 studies met the inclusion criteria, of which 14 were included in the meta-analyses, encompassing 2725 patients. A pooled neuropathic pain prevalence after axillary procedures of 22.6% (95% confidence interval [CI], 15.5-30.6) was estimated in the meta-analysis. The meta-analyses on ALND (10 studies, 1253 patients) and SLNB (5 studies, 860 patients) revealed an estimated pooled prevalence of 26.9% (95% CI, 17.1-37.9) and 18.8% (95% CI, 10.5-28.5), respectively. Neuropathic pain affects approximately 1 in 5 breast cancer patients following axillary surgery, with higher rates after ALND than SLNB.