Comparison of Range of Motion (ROM) Limitations and Lymphedema in Breast Cancer Patients Following Axillary Lymph Node Dissection (ALND) and Sentinel Lymph Node Biopsy (SLNB): A Systematic Review

Authors

  • I G A Gita Dewi Rahmautami Universitas Udayana, Indonesia
  • I Gede Wikania Wiraguna Universitas Udayana, Indonesia
  • Hendry Irawan Universitas Udayana, Indonesia
  • I Nyoman Wawan Tirtayasa Universitas Udayana, Indonesia
  • ⁠I Gede Tuban Eling Tulus Widiana Universitas Udayana, Indonesia

DOI:

https://doi.org/10.46799/jhs.v7i2.2801

Keywords:

Axillary lymph node dissection, breast cancer, sentinel lymph node biopsy

Abstract

Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are widely used surgical procedures for breast cancer management. Previous studies have reported a lower incidence of range of motion (ROM) limitations and lymphedema following SLNB. However, no systematic review has been conducted to consolidate these findings. This research aims to systematically compare the incidence of ROM limitations and lymphedema in breast cancer patients undergoing ALND versus SLNB. The methods follow PRISMA 2020 guidelines, with a literature search conducted using PubMed, ScienceDirect, and Cochrane databases. The population included early-stage invasive breast cancer patients who underwent either SLNB or ALND. A qualitative analysis was performed to assess postoperative ROM limitations and lymphedema. Ten studies involving 8,523 patients were included. Both procedures were applied to patients with operable, early-stage invasive breast cancer. Qualitative analysis indicated that SLNB was generally associated with fewer postoperative complications, particularly in terms of ROM limitation and lymphedema. Some studies reported similar outcomes for both techniques regarding ROM limitation and lymphedema, but SLNB showed better outcomes in terms of postoperative complications such as lymphedema and ROM limitation. However, heterogeneity in definitions, assessment methods, lymph node involvement, and surgical techniques was noted across studies. This systematic review suggests that SLNB is associated with a lower incidence of ROM limitations and lymphedema compared to ALND, supporting its use as a less morbid surgical approach in early-stage breast cancer.

References

Ashikaga, T., Krag, D. N., Land, S. R., Julian, T. B., Anderson, S. J., Brown, A. M., Skelly, J. M., Harlow, S. P., Weaver, D. L., Mamounas, E. P., Costantino, J. P., & Wolmark, N. (2010). Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. Journal of Surgical Oncology, 102(2), 111–118. https://doi.org/10.1002/jso.21535

Belmonte, R., Garin, O., Segura, M., Pont, A., & Escalada, F. (2012). Quality-of-Life Impact of Sentinel Lymph Node Biopsy Versus Axillary. JVAL, 15(6), 907–915. https://doi.org/10.1016/j.jval.2012.06.003

Belmonte, R., Messaggi-Sartor, M., Ferrer, M., Pont, A., & Escalada, F. (2018). Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB. Supportive Care in Cancer, 26(9), 3277–3287. https://doi.org/10.1007/s00520-018-4186-1

Cao, D., Chandiramani, R., Chiarito, M., Claessen, B. E., & Mehran, R. (2021). Evolution of antithrombotic therapy in patients undergoing percutaneous coronary intervention: a 40-year journey. European Heart Journal, 42(4), 339–351.

Chang, D. W., Schofield, P., Bressel, M., Chua, B. H., Hansen, C., & Blinman, P. (2019). Axillary dissection in sentinel lymph node positive breast cancer : Is the staging information worthwhile for patients ? January, 1–8. https://doi.org/10.1111/ajco.13238

De Bree, R., Takes, R. P., Castelijns, J. A., Medina, J. E., Stoeckli, S. J., Mancuso, A. A., Hunt, J. L., Rodrigo, J. P., Triantafyllou, A., & Teymoortash, A. (2015). Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head & Neck, 37(12), 1829–1839.

Ehteshami Bejnordi, B., Veta, M., Johannes van Diest, P., Van Ginneken, B., Karssemeijer, N., Litjens, G., Van Der Laak, J. A. W. M., consortium, C., Hermsen, M., & Manson, Q. F. (2017). Diagnostic assessment of deep learning algorithms for detection of lymph node metastases in women with breast cancer. Jama, 318(22), 2199–2210.

Francis, W. P., Abghari, P., Du, W., Rymal, C., Suna, M., & Kosir, M. A. (2006). Improving surgical outcomes: standardizing the reporting of incidence and severity of acute lymphedema after sentinel lymph node biopsy and axillary lymph node dissection. American Journal of Surgery, 192(5 SPEC. ISS.), 636–639. https://doi.org/10.1016/j.amjsurg.2006.08.018

Lucci, A., McCall, L. M., Beitsch, P. D., Whitworth, P. W., Reintgen, D. S., Blumencranz, P. W., Leitch, A. M., Saha, S., Hunt, K. K., & Giuliano, A. E. (2007). Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 25(24), 3657–3663. https://doi.org/10.1200/JCO.2006.07.4062

Marino, M. A., Avendano, D., Zapata, P., Riedl, C. C., & Pinker, K. (2020). Lymph node imaging in patients with primary breast cancer: concurrent diagnostic tools. The Oncologist, 25(2), e231–e242.

Occhipinti, G., Laudani, C., Galli, M., Ortega-Paz, L., Kunadian, V., Mendieta, G., Rinaldi, R., Andreotti, F., Mehran, R., & López-Sobrino, T. (2025). Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: a network meta-analysis. European Heart Journal, ehaf473.

Potpara, T., Grygier, M., Haeusler, K. G., Nielsen-Kudsk, J. E., Berti, S., Genovesi, S., Marijon, E., Boveda, S., Tzikas, A., & Boriani, G. (2024). Practical guide on left atrial appendage closure for the non-implanting physician: an international consensus paper. Europace, 26(4), euae035.

Pourmir, I., Van Halteren, H. K., Elaidi, R., Trapani, D., Strasser, F., Vreugdenhil, G., & Clarke, M. (2024). A conceptual framework for cautious escalation of anticancer treatment: How to optimize overall benefit and obviate the need for de-escalation trials. Cancer Treatment Reviews, 124, 102693.

Roy, P., Leizorovicz, A., Villet, R., Mercier, C., & Bobin, J. Y. (2018). Systematic versus sentinel-lymph-node-driven axillary-lymph-node dissection in clinically node-negative patients with operable breast cancer. Results of the GF-GS01 randomized trial. Breast Cancer Research and Treatment, 170(2), 303–312. https://doi.org/10.1007/s10549-018-4733-y

Sibbing, D., Aradi, D., Alexopoulos, D., Ten Berg, J., Bhatt, D. L., Bonello, L., Collet, J.-P., Cuisset, T., Franchi, F., & Gross, L. (2019). Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention. JACC: Cardiovascular Interventions, 12(16), 1521–1537.

Wetzig, N., Gill, P. G., Espinoza, D., Mister, R., Stockler, M. R., Gebski, V. J., Ung, O. A., Campbell, I., & Simes, J. (2017). Sentinel-Lymph-Node-Based Management or Routine Axillary Clearance? Five-Year Outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 Trial: Assessment and Incidence of True Lymphedema. Annals of Surgical Oncology, 24(4), 1064–1070. https://doi.org/10.1245/s10434-016-5669-2

Woo, S., Suh, C. H., Kim, S. Y., Cho, J. Y., & Kim, S. H. (2018). The diagnostic performance of MRI for detection of lymph node metastasis in bladder and prostate cancer: an updated systematic review and diagnostic meta-analysis. American Journal of Roentgenology, 210(3), W95–W109.

Yahata, H., Kodama, K., Okugawa, K., Hachisuga, K., Yasutake, N., Maenohara, S., Yagi, H., Yasunaga, M., Ohgami, T., & Onoyama, I. (2022). Long-term follow up after sentinel node biopsy alone for early-stage cervical cancer. Gynecologic Oncology, 165(1), 149–154.

Zaveri, S., Everidge, S., FitzSullivan, E., Hwang, R., Smith, B. D., Lin, H., Shen, Y., Lucci, A., Teshome, M., & Sun, S. X. (2023). Extremely low incidence of local-regional recurrences observed among T1-2 N1 (1 or 2 positive SLNs) breast cancer patients receiving upfront mastectomy without completion axillary node dissection. Annals of Surgical Oncology, 30(12), 7015–7025.

Zhang, J. Q., Montagna, G., Sevilimedu, V., Abbate, K., Charyn, J., Mehrara, B., Morrow, M., & Barrio, A. V. (2023). Longitudinal Prospective Evaluation of Quality of Life after Axillary Lymph Node Dissection. 1–18.

Downloads

Published

2026-03-03

Issue

Vol. 7 No. 2 (2026): Journal Health Sains

Section

Articles

License

Copyright (c) 2026 I G A Gita Dewi Rahmautami, I Gede Wikania Wiraguna, Hendry Irawan, I Nyoman Wawan Tirtayasa, ⁠I Gede Tuban Eling Tulus Widiana

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Authors who publish with this journal agree to the following terms:

  • Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aCreative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  • Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  • Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.