Quality of life and oncologic safety of axillary reverse mapping in patients with breast cancer: a systematic review and meta-analysis

Background:The axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving upper extremity lymphatic drainage. In this article, we evaluated the quality of life and oncologic outcomes of ARM used in patients with breast cancer.Methods:PubMed, Embase, and other databases were searched for relevant articles published between 2013 and 2022. Randomized clinical trials were identified and included in the meta-analysis. The evaluated endpoints included lymphedema, the number of retrieved lymph nodes (LNs), the number of patients with positive LNs, and shoulder restriction. A meta-analysis was performed using RevMan 5.3 software. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to analyze dichotomous data.Results:Seven studies involving 1,820 patients were included for the meta-analysis, which revealed that ARM was associated with a reduced incidence of lymphedema (OR, 0.30; 95% CI, 0.16-0.58; P = 0.0003). There were no significant differences in the number of retrieved LNs, the number of patients with positive LNs, and shoulder restriction between the two groups.Conclusion:The ARM procedure achieved comparable success with a better quality of life and acceptable safe oncologic outcomes for patients with breast cancer. Future multicenter randomized controlled trials are needed to further evaluate the efficacy and safety of ARM.