Mortality comparison between axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SND) among breast cancer pantient: A meta-analysis and systematic review study

Introduction: Axillary lymph node dissection (ALND) is a crucial surgical procedure for breast cancer. It has guaranteed locoregional control of the disease, guided adjuvant therapy, and functioned as a staging tool. However, over the past 25 years, a more conservative approach has become the standard for surgical management of the axilla. Because sentinel lymph node biopsy (SNB) is less invasive and less morbid than axillary lymph node dissection (ALND), it has become the standard surgical procedure for axillary staging of clinically node-negative breast cancer. This study aimed to compare the mortality of breast cancer patients receiving ALND and SNB procedure. Methods: Our review includes randomized controlled trials of breast cancer patients undergoing ALND or SNB surgical techniques. A systematic literature search was performed from PubMed on December 2023 to search for articles reporting on survival rates between ALND vs SNB among breast cancer patients. The data obtained then underwent statistical evaluation, and a meta-analysis was conducted using Review Manager 5.4. In order to represent primary outcomes, the risk ratio was estimated using an inverse variance technique with a random-effects model. Heterogeneity was presented with total values, 95% confidence intervals (CI), and I values. Results: As many as 208 articles were found in the PubMed database search, and only six studies were included in this study. The six included trials all used chemotherapy and radiotherapy for systematic treatment. The length of follow-up varied from 33 months to 15 years. The total number of patients in the trials was 3,585, and the study period was from 2011 to 2023. The pooled analysis of the mortality outcomes showed that the heterogeneity of the data was low (I2 21%, p = 0.4). In the pooled analysis, the mortality of patients with SNB for surgical treatment was not significantly different compared to patients with ALND (OR:0.88; 95% CI:0.65-1.19). Conclusion: The mortality of patients undergoing SNB and ALND does not differ significantly, according to this pooled study. It demonstrates that the group without axillary dissection had a primary survival outcome that was not inferior to that of the dissection group.