Meta-analysis to determine the clinical effectiveness of axillary lymph node dissection in the treatment of operable primary breast cancer.

1112 Background: The optimum surgical management of the axilla is controversial. Guidelines mandate axillary surgery in the setting of positive sentinel nodes. However, recent studies have questioned the oncological benefits of this potentially morbid procedure. Therefore a meta-analysis of relevant randomised trials was performed to clarify this issue. Methods: A comprehensive search of published randomized trials that compared patients with primary operable breast cancer with/without axillary lymph node dissection (ALND) was performed using MEDLINE and available data was cross referenced. Reviews of each study were conducted, and data were extracted. Primary outcomes were overall survival and recurrent axillary disease. Results: A total of 4,759 patients with operable primary breast cancer were identified from 13 randomised controlled trials comparing patients with/without ALND. Overall survival favours patients not having ALND (OR = 1.38 (95% CI = 1.12 TO 1.69, p=0.002)) however patients undergoing ALND had similar disease free survival (OR=1.04 (95% CI= 083-1.31, p=0.7). However, though axillary recurrence was uncommon it was significantly less so following ALND (1% vs. 5 %, p<0.05, ALND vs. No ALND). Conclusions: Based on this meta-analysis, ALND does not appear to positively impact on breast cancer survival. Enhanced and targeted adjuvant treatment strategies may facilitate less aggressive axillary surgery. The management and implications of a positive sentinel node need to be re-evaluated in this regard.