Sentinel lymph node based management or routine axillary clearance? Three-year outcomes of the RACS Sentinel Node Biopsy Versus Axillary Clearance (SNAC) 1 trial

Published online: 15 October 2014. On behalf of the SNAC Trial Group of the Royal Australasian College of Surgeons and NHMRC Clinical Trials Centre.Purpose: To determine whether the benefits of sentinel node based management (SNBM) over routine axillary clearance (RAC) at 1 year persisted to 3 years of follow-up. Methods: A total of 1,088 women with clinically node-negative breast cancer were randomly assigned to the SNBM or RAC group. Upper limb volume, symptoms, and function were assessed at 1, 6, 12, 24, and 36 months after surgery objectively with upper limb measurements by clinicians and subjectively by patients’ using validated self-rating scales. Results: Upper limb volume increased in both groups over the first 2 years and differed between the two groups all time points beyond 1 month (P < 0.02) but then plateaued. Upper limb swelling was no worse in women who had axillary clearance as a two-stage procedure than in women assigned RAC as a one-stage procedure. Upper limb volume had increased 15 % or more in 6.0 % at 6 months and 17.6 % at 3 years in those assigned RAC versus 4.2 and 11.9 % in those assigned SNBM. Reductions in upper limb movement were also greater, with RAC than SNBM over 6 months, but improved and were similar in the two groups from 1 to 3 years. Subjective ratings of upper limb swelling, symptoms, dysfunction, and disability over 3 years were worse in the RAC group. Upper limb swelling at 3 years was rated severe by few women (1.1 %) but was rated as moderate by 9.4 % in the RAC group and 2.5 % in the SNBM group (P < 0.001). Conclusions: The benefits of SNBM over RAC persist 3 years after surgery.Neil Wetzig, Peter Grantley Gill, Diana Zannino, Martin R. Stockler, Val Gebski, Owen Ung, Ian Campbell and R. John Sime