Axillary Surgery in Sentinel Node-Positive Breast Cancer After Neoadjuvant Therapy: A Systematic Review and Meta-analysis
In brief
Skipping completion ALND gives similar low axillary recurrence in residual node-positive breast cancer
In five non-randomized studies of 4,670 patients with residual nodal disease after neoadjuvant therapy, omitting completion axillary dissection resulted in axillary recurrence rates of 0.4-5.7%, essentially identical to those after full dissection, and survival outcomes were comparable. The finding suggests that, when regional radiation is used, less extensive surgery may spare patients morbidity, but prospective trials are still needed.
- Journal
- Clinical breast cancer (Q2)
- Published
- 13 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Rim El Annan, Mohamad El-Jammal, Youssef H Zeidan
- PMID
- 42710223
- DOI
- 10.1016/j.clbc.2026.08.006
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 13 September 2026).
Abstract
The oncologic value of axillary lymph node dissection (ALND) for residual node-positive (ypN+) breast cancer after neoadjuvant therapy is uncertain when regional nodal irradiation (RNI) is routinely used. We systematically reviewed comparative evidence on locoregional control and survival outcomes with omission versus completion of ALND. PubMed/MEDLINE, Embase, and Cochrane Central were searched from 2000 to 2025 for English-language studies comparing completion ALND with omission of ALND (sentinel lymph node biopsy and/or targeted axillary dissection) among patients with biopsy-proven node-positive breast cancer treated with neoadjuvant therapy who had residual nodal disease at surgery. Two reviewers screened studies and extracted outcomes. We identified 445 initial records for screening and review. Five nonrandomized comparative studies, including 4670 patients, met inclusion criteria and directly compared ypN+ outcomes by axillary surgery extent. In cohorts where RNI was commonly administered, axillary recurrence was uncommon (0.37%-5.7% without ALND and 0.4%-4.8% with ALND). Meta-analysis of comparative studies showed no clear difference in axillary recurrence with omission versus completion of ALND (pooled RR 1.09, 95% CI, 0.47-2.52; P = .80), with moderate heterogeneity (I² = 46%). In selected ypN+ patients treated with RNI, omission of completion ALND appears to yield low axillary recurrence and similar survival outcomes while potentially reducing surgical morbidity. Randomized trials and long-term results of prospective studies are needed to further guide axillary management of patients with residual nodal burden after neoadjuvant therapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.