Breast Cancer Research and Treatment

, Volume 153, Issue 2, pp 235–240 | Cite as

Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer

  • D. P. Joyce
  • A. Manning
  • M. Carter
  • A. D. K. Hill
  • M. R. Kell
  • M. Barry


There are divergent opinions regarding the optimum surgical management of the axilla in patients with invasive breast cancer. Guidelines mandate axillary lymph node dissection (ALND) in the setting of positive sentinel lymph nodes. However, recent studies have questioned the true benefits of this procedure. Therefore, a meta-analysis of relevant randomized trials was performed in order to clarify the oncological benefit of axillary lymph node dissection. A comprehensive search of published randomized trials that compared patients with primary operable breast cancer with/without ALND was performed using MEDLINE, and available data were cross-referenced. Reviews of each study were conducted, and data were extracted. Primary outcomes were overall survival and recurrent axillary disease. A total of 7347 patients with operable primary breast cancer were identified from 8 randomised controlled trials comparing axillary recurrence in patients with or without ALND. Six of these trials provided data on overall survival on 6895 patients. Overall survival favours patients having ALND (OR = 1.22 (95 % CI 1.03–1.44, p = 0.02). Similarly, patients undergoing ALND had increased recurrence-free survival (OR = 2.25 (95 % CI 1.28–3.94, p = 0.0047). ALND appears to positively impact on overall and recurrence-free survival from breast cancer. These data highlight the enduring benefits of ALND in an era where adjuvant therapies are being promoted to manage regionally advanced/metastatic disease.


Breast cancer Axillary lymph node dissection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • D. P. Joyce
    • 1
  • A. Manning
    • 1
  • M. Carter
    • 1
  • A. D. K. Hill
    • 2
  • M. R. Kell
    • 1
  • M. Barry
    • 1
  1. 1.Department of Breast SurgeryMater Misericordiae University HospitalDublin 7Ireland
  2. 2.Department of Breast and Endocrine Surgery, Royal College of SurgeonsBeaumont HospitalDublin 9Ireland

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