{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:15:08Z","timestamp":1788347708899,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate long\u2010term shoulder outcomes after sentinel lymph\u2010node biopsy (SLNB) versus axillary lymph\u2010node dissection (ALND) and identify predictors of chronic shoulder dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      This prospective multicenter study enrolled 1111 women (\u2265\u200918\u2009years) undergoing breast cancer surgery with SLNB (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009931) or ALND (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009180) across five tertiary hospitals between October 2022 and June 2024. Functional outcomes were assessed using QuickDASH, range\u2010of\u2010motion (ROM), daily\u2010activity limitations, pain, axillary web syndrome (AWS), and lymphedema. Multivariable regression identified independent predictors of poor shoulder function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ALND was associated with consistently greater morbidity. Mean QuickDASH scores were 17.1\u2009\u00b1\u200910.5 after ALND versus 11.5\u2009\u00b1\u20099.8 after SLNB (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). ROM limitation (38.3% vs. 20.0%), reduced daily\u2010activity performance (41.1% vs. 23.1%), AWS (13.9% vs. 7.0%), and lymphedema (16.1% vs. 4.2%) were all more frequent after ALND (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.002). Pain intensity was higher (2.28\u2009\u00b1\u20092.82 vs. 1.31\u2009\u00b1\u20092.11;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable analysis, ALND (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20091.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher BMI (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and depressive disorders (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) independently predicted worse shoulder function; age and physiotherapy timing were not significant. Functional deficits persisted across lumpectomy and mastectomy subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ALND is associated with greater long\u2010term shoulder dysfunction compared with SLNB. Obesity and depressive symptoms exacerbate morbidity, highlighting the importance of comprehensive survivorship rehabilitation.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT05950685\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70745","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:01:42Z","timestamp":1779256902000},"page":"2072-2080","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Shoulder Dysfunction After Breast and Axillary Surgery: Impact of Surgical Extent and Predictors of 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