Abstract P2-12-05: Trans-peri-areolar breast conservative surgery followed by endoscopic axillary lymph node dissection: A novel surgical option
Authors: Yang W , Sejdinaj F , Shen L , Zhu W , Wang H , Zhang H 
Published: May 2016

Objective

Endoscopic surgery currently is a standard method in most surgical fields. Although endoscopic breast surgery has been introduced since 1993, it is not widely applied due to limited benefits. Changing the conventional local treatment may require new attempts that enhance cosmetic outcomes and diminish complication rates. We report the cosmetic outcomes and postoperative complications of a breast conservative surgery (EBCS) procedure, which consists in using a 3cm peri-areolar incision to perform lumpectomy, and followed by endoscopic axillary lymph node dissection without liposuction.

Patients and methods

From Nov 2013 till May 2015, 53 patients diagnosed with early stage breast cancer were categorized into the conventional breast conservative surgical group (CBCS)and EBCS group.

Indications for EBCS were

1.tumor/breast ratio below 20%

2.no distant metastasis

3.Tumor mass not located in the lower-inferior quadrant.

Inform consents were obtained from all patients. 25 patients were enrolled in the EBCS and 28 patients in the CBCS group. Number of lymph nodes harvested, tumor size, intra-operative bleeding, drainage volume, pain score (10scale survey) were collected.

The breast symmetrical score (BSS,direct distance from nipple to fovea jugularis,midclavicular, midsternal, inframammary fold and anterior axillary line of both breast was measured 3days after surgery and distance difference ratio of operated to contralateral site was calculated. BSS is the sum of each absolute value of distance difference ratio) and patient satisfaction (4scale survey) were used to evaluate cosmetic outcomes.

Results

There was no statistical difference in intra-operative bleeding(EBCS:36.00±17.08ml, CBCS:29.29±19.99ml,P=0.20) and drainage volume(EBCS:124.60±50.22, CBCS:120.82±74.58,P=0.832).An increased number of harvested lymph nodes was observed in the EBCS group(EBCS:17.88±6.21,CBCS:14.25±5.82,P=0.03). No statistical difference reported for lymph metastasis among two groups(EBCS:1.68±3.59, CBCS:0.96±1.45,P=0.34) .The average tumor size showed no difference(EBCS: 2.41±0.87, CBCS:1.96±0.95,P=0.07). The pain score (EBCS:3.88±1.53, CBCS:4.39±0.74, P=0.04) meanwhile BSS was significantly superior in the EBCS group(EBCS:0.097±0.084,CBCS:0.20±0.13,P=0.002). Patient satisfaction survey reported a positive feedback(EBCS:4.00±0.00,CBCS:3.68±0.48,P=0.001).

Cosmetic outcomes and complications of endoscopic breast conservative surgery EBCSCBCSPbleeding36.00±17.0829.29±19.990.20drainage volume124.60±50.22120.82±74.580.832number of lymph nodes harvested17.88±6.2114.25±5.820.03pain score3.88±1.534.3±0.740.04breast symmetry score0.097±0.0840.20±0.130.002

Conclusions.

We evaluated cosmetic outcome using a thorough BSS as an index plus adding the lack of scar in the axilla. EBCS patients displayed a significantly superior outcome in comparison with CBCS, which was further appraised by a considerable satisfied patient's feedback.

Evaluation of long-term survival, complication rates and cosmetic results are mandatory in order to further estimate the applicability of this surgical management in treatment of breast cancer. EBCS may be a feasible surgical alternative with minimal invasiveness, suitable to patients demanding excellent cosmetic outcome.

Citation Format: Yang W, Sejdinaj F, Shen L, Zhu W, Wang H, Zhang H. Trans-peri-areolar breast conservative surgery followed by endoscopic axillary lymph node dissection: A novel surgical option. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-05.