1016 Assessing the Impact of Axillary Lymph Node Dissection on 30-Day Breast Cancer Surgery Outcomes Across Global Income Settings

Abstract

Abstract Aim To determine the impact of axillary lymph node dissection (ALND) for breast cancer on 30-day mortality and complication rates across different income settings. Method GlobalSurg3 was a multicentre, international prospective cohort study of patients undergoing surgery for breast cancer. Primary outcomes were death, major complications (Clavien-Dindo III/IV) or surgical site infection (SSI), as defined by the CDC criteria, within 30 days of surgery. Income levels were defined using the World Bank classification. Patient characteristics, presentation and disease factors were analysed across income levels. Multivariate logistic regression models were used to determine the impact of ALND across income group. Results This analysis included 8,406 patients undergoing surgery for breast cancer. Most patients presented with invasive ductal carcinoma (75%). The number of lymph nodes within resection samples were higher in low-lower middle-income countries (mean 13.3, SD 7.8) than in high income countries (mean 4.6, SD 6.3). Mortality and major complication rates were similar across country income groups. However, SSI was elevated in low/lower middle groups (aOR 2.33, 95% CI 1.75–3.12) than in upper middle income (aOR 1.86, 95% CI 1.34–2.59) and high-income groups when ALND was performed. The risk of readmission was also higher. Conclusions Major outcomes following ALND in patients with breast cancer were similar, however the high rate of SSI seen in LMICs is likely to significantly impact patient quality of life and potentially delay adjuvant treatment when available. Higher lymph node clearance within this setting may reduce the risk of recurrence but to the detriment of short-term outcomes.