Six RCTs (2,936 patients) were included.
Studies were conducted between 1951 and 1987.
Improved survival from ALND: the difference in survival rate was 5.45% (95% CI: 2.65, 8.1). Bayesian analysis: 5.4% (95% CI: 2.7, 8.0).
Improved survival from ALND after correction for adjuvant chemotherapy: Bayesian analysis showed improvement of 5.4% (95% CI: 2.8, 8.1).
Improved survival from ALND for Stage I patients: 5.6% (95% CI: 2.9, 8.4).
Improved survival from ALND after the inclusion of two unpublished studies: 4.4% (95% CI: 1.9, 6.9).
Improved survival from ALND from trials with 10 year follow-up (4 studies): all trials showed survival benefit ranging from 2.7 to 7.9%, with 1 trial showing a statistically-significant improvement.
Effect of individual trials: after removing the one trial with a significant effect the survival benefit was 7.3% (95% CI: 3.2, 11.3).