Imperial College London
Alternate

Richard M Kwasnicki PhD MRCS

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
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Contact

 

+44 (0)20 3312 5140richard.kwasnicki07

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Che:2023:10.1097/SLA.0000000000005671,
author = {Che, Bakri NA and Kwasnicki, R and Khan, N and Ghandour, O and Lee, A and Grant, Y and Dawidziuk, A and Darzi, A and Ashrafian, H and Leff, D},
doi = {10.1097/SLA.0000000000005671},
journal = {Annals of Surgery},
pages = {572--580},
title = {Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis},
url = {http://dx.doi.org/10.1097/SLA.0000000000005671},
volume = {277},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective: To evaluate the impact of ALND and SLNB on upper limb (UL) morbidity in breastcancer patients.Summary Background: Axillary de-escalation is motivated by a desire to reduce harm ofALND. Understanding the impact of axillary surgery and disparities in operative procedureson post-operative arm morbidity would better direct resources to the point of need and cementthe need for de-escalation strategies.Methods: Embase, Medline, CINAHL and PsychINFO were searched from 1990 until March2020. Included studies were randomized-controlled and observational studies focusing on ULmorbidities, in breast surgery patients. The study followed the Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of upper limbmorbidity comparing SLNB and ALND at less than 12 months, 12-24 months and beyond 24months were analyzed.Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedemaand pain after ALND compared to SLNB. The difference in lymphedema and pain prevalencebetween SLNB and ALND was 13.7% (95% CI 10.5-16.8, p<0.005) and 24.2% (95% CI 12.1-36.3, p<0.005) respectively. Pooled estimates for prevalence of reduced strength and rangeof motion after SLNB and ALND were 15.2% vs 30.9% and 17.1% vs 29.8% respectively.Type of axillary surgery, greater BMI, and radiotherapy were some of the predictors for ULmorbidities.Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated.ALND patients experienced greater rates of lymphedema, pain, reduced strength, and ROMcompared to SLNB. The findings support the continued drive to de-escalate axillary surgery.
AU  - Che,Bakri NA
AU  - Kwasnicki,R
AU  - Khan,N
AU  - Ghandour,O
AU  - Lee,A
AU  - Grant,Y
AU  - Dawidziuk,A
AU  - Darzi,A
AU  - Ashrafian,H
AU  - Leff,D
DO  - 10.1097/SLA.0000000000005671
EP  - 580
PY  - 2023///
SN  - 0003-4932
SP  - 572
TI  - Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000005671
UR  - http://hdl.handle.net/10044/1/98350
VL  - 277
ER  -
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