Originally published as JCO Early Release 10.1200/JCO.2006.07.4062 on May 7 2007
Journal of Clinical Oncology, Vol 25, No 24 (August 20), 2007: pp. 3657-3663
© 2007 American Society of Clinical Oncology.
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
Anthony Lucci,
Linda Mackie McCall,
Peter D. Beitsch,
Patrick W. Whitworth,
Douglas S. Reintgen,
Peter W. Blumencranz,
A. Marilyn Leitch,
Sukumal Saha,
Kelly K. Hunt,
Armando E. Giuliano
From the Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston; Dallas Surgical Group; The University of Texas Southwestern, Dallas, TX; American College of Surgeons Oncology Group, Durham, NC; Nashville Breast Center, Nashville, TN; Lakeland Cancer Center, Lakeland; Morton Plant Mease Healthcare, Clearwater, FL; McClaren Regional Medical Center, Flint, MI; and John Wayne Cancer Institute, Santa Monica, CA
Address reprint requests to Anthony Lucci, MD, Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: alucci{at}mdanderson.org
Purpose The American College of Surgeons Oncology Group trial Z0011 was a prospective, randomized, multicenter trial comparing overall survival between patients with positive sentinel lymph nodes (SLNs) who did and did not undergo axillary lymph node dissection (ALND). The current study compares complications associated with SLN dissection (SLND) plus ALND, versus SLND alone.
Patients and Methods From May 1999 to December 2004, 891 patients were randomly assigned to SLND + ALND (n = 445) or SLND alone (n = 446). Information on wound infection, axillary seroma, paresthesia, brachial plexus injury (BPI), and lymphedema was available for 821 patients.
Results Adverse surgical effects were reported in 70% (278 of 399) of patients after SLND + ALND and 25% (103 of 411) after SLND alone (P  .001). Patients in the SLND + ALND group had more wound infections (P .0016), seromas (P .0001), and paresthesias (P .0001) than those in the SLND-alone group. At 1 year, lymphedema was reported subjectively by 13% (37 of 288) of patients after SLND + ALND and 2% (six of 268) after SLND alone (P .0001). The difference between the two groups' lymphedema, assessed by arm measurements at 30 days (P = .36), 6 months (P = .22), and 1 year (P = .078), although close to the cutoff for significance at 1 year, was not significant. BPIs occurred in less than 1% of patients.
Conclusion In trial Z0011, the use of SLND + ALND resulted in more wound infections, axillary seromas, and paresthesias than SLND alone. Lymphedema was more common after SLND + ALND but was significantly different only by subjective report. The use of SLND alone resulted in fewer complications.
published online ahead of print at www.jco.org on July 23, 2007.
Supported by the National Cancer Institute Grant No. U10-CA76001-09.
Presented in part at the Annual Meeting of the Society of Surgical Oncology, March 23-26, 2006, San Diego, CA.
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
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