Abstract P3-13-24: Non-liposuctive endoscopic axillary lymph node dissection in breast conservative surgery
Authors: Yang W , Zhang H , Wang H 
Published: March 2017

Objective

Limiting surgical invasiveness is the main theme of breast surgery. Endoscopic axillary lymph node dissection (EALND) has been introduced since 1993 but not widely applied due to limited benefits as well as the controversy of liposuction that needed to create the working space in axilla. Progress of energy instruments brings the opportunity to new attempts to further enhance cosmetic outcomes and diminish complication rates. In this study, we report the preliminary outcomes of non-liposuctive EALND (NEALND) in breast conservative surgery.

Patients and methods

From Nov 2013 till June 2016, 143 patients diagnosed with cN+ breast cancer were categorized into two separate groups, the conventional ALND(CALND, 71 patients) and NEALND group(72 patients).

Inform consents were obtained from all patients. Number of lymph nodes harvested, tumor size, intra-operative bleeding, drainage volume, pain score (10scale survey) were collected.

The breast symmetrical score (BSS) and patient satisfaction (4scale survey) were used as variables to evaluate cosmetic outcomes.

Results

There was no statistical difference in intra-operative bleeding(NEALND:31.33±20.22ml, CALND:38.00±18.21ml, P=0.31) and first postoperative 3 day axillary drainage volume(NEALND:62.30±32.42, CALND:69.67±35.44, P=0.11). A slightly increased in the number of harvested lymph nodes was observed in the NEALND group in comparison with CALND (NEALND: 17.34±6.55, CALND: 14.68±5.85, P=0.03), there was no statistical difference reported for distant metastasis among two groups(NEALND:2.68±3.59, CALND:2.55±1.31,P=0.54). The pain score (NEALND: 3.79±1.51, open: 4.41±0.96, P=0.04) meanwhile breast symmetrical score was significantly superior in the NEALND group in comparison with CALND (NEALND: 0.098±0.091, CALND: 0.25±0.14, P=0.001) . Patient satisfaction survey reported a slightly positive feedback(NEALND: 4.00±0.00, CALND:3.77±0.54, P=0.02). In the CALND group, slight to moderate skew of nipple position towards the axilla was observed in many cases, suggesting the side effect of axillary scar contracture. The average operation time for NEALND was about 90min in the first 20 cases, and then down to about 60min, so the learning curve is suggested as 20 cases. All the patients are under follow up with no recurrence to date

Conclusions

Efforts on minimizing surgical invasiveness are greatly developed in systemic treatment and non-surgical local control. However, surgery is the fastest and the most economical way to obtain pathological complete remission, and still has space to be completed. NEALND may be a feasible surgical alternative with minimal invasiveness, suitable to a category of patient demanding excellent cosmetic outcome. Evaluation of long-term survival, complication rates and cosmetic results are mandatory in order to further estimate the applicability of this type of surgical management in treatment of breast cancer.

References

Suzanne FY, et al. A new, non-traumatic technique about axillary lymphadenectomy using fat and lymph nodes suction aspiration. A study of thirty cases. Breast Cancer Res Treat, 1993 ,27 :188.

Citation Format: Yang W, Zhang H, Wang H. Non-liposuctive endoscopic axillary lymph node dissection in breast conservative surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-24.