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Xiong H, Chen Z, Xu L, Chen C, Fu Q, Teng R, Chen J, Xie S, Wang L, Yu XF, Zhou J. Contrast of Mastoscopic and Conventional Axillary Lymph Node Dissection of Patients With Breast Cancer: Meta-Analysis. Cancer Control 2021; 27:1073274820932987. [PMID: 32602366 PMCID: PMC7328363 DOI: 10.1177/1073274820932987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Mastoscopic axillary lymph node dissection (MALND) is a currently used and safe
surgical treatment option for breast cancer. However, the extensive application
of MALND is still debatable because of the use of conventional axillary lymph
node dissection (CALND). Therefore, in the current study, we aimed to compare
the efficacy and safety of MALND and CALND for obtaining evidence-based
conclusions about the short-term and long-term outcomes of MALND for patients
with breast cancer. PubMed, Web of Science, Cochrane Library, and CNKI were
comprehensively searched for articles published between January 1998 and January
2019. Then Newcastle-Ottawa scale was used for quality assessment. The Review
Manager software version 5.0 was utilized for generating forest maps and funnel
plots. Twelve studies including 2157 patients were selected for the
meta-analysis. There were no significant differences in the number of lymph node
dissections, tumor recurrence rate, axillary drainage, postoperative
hospitalization time, and tumor size between the MALND and CALND groups
(P > .05). In the MALND group, the surgery time was
longer, while the incidence of intraoperative bleeding was lesser and the
duration of drainage was shorter than those in the CALND group
(P < .01). The complications in the MALND group were
also fewer than those in the CALND group (P < .05). The
results of the current study showed that MALND is reliable and feasible for
breast cancer owing to the lesser incidence of intraoperative bleeding, shorter
drainage duration, and lower incidence of complications compared to CALND.
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Affiliation(s)
- Hanchu Xiong
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China.,Cancer Institute, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zihan Chen
- Surgical Intensive Care Unit, First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ling Xu
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cong Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingshuang Fu
- Rui An Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Rongyue Teng
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jida Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuduo Xie
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Linbo Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao-Fang Yu
- Cancer Institute, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jichun Zhou
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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Liang Y, Xu S. Nonliposuction Endoscopic Sentinel Lymph Node Biopsy Through the Periareolar Incision. Surg Innov 2020; 27:570-579. [PMID: 32687735 DOI: 10.1177/1553350620942983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Sentinel lymph node biopsy (SLNB) has been an alternative to axillary lymph node dissection as a standard procedure for breast cancer patients with clinically negative lymph nodes. Endoscopic technique has been developed for over 20 years but remains to be mastered by a slice of surgeons. Suction and squeezing in the liposuction endoscopic procedures may increase risk of local recurrence and metastasis. In this study, we present our method of SLNB procedure through the periareolar incision which improves the shape of the breast-conserving surgery. Patients and Procedures. Twenty-eight breast cancer patients with clinically negative lymph nodes received this procedure. Methylene blue dye and technetium-99m sulfur colloid were used to be the tracker of sentinel lymph nodes (SLNs). Periareolar incision was the main surgical technique. The STORZ HD endoscopic system and some special instruments were used during the operation. Results. SLNs can be accurately located and biopsied under an endoscope without additional incisions. The SLNs detection rate, sensitivity, and false-negative rate are 88%, 80%, and 11.1%, respectively. And, the complications such as paresthesia and upper limb lymphedema are similar compared with traditional breast-conserving surgery (10.7% vs 9.8% and 7.1% vs 7.8%). Conclusion. Endoscopic technique can be used to accurately assess the status of SLNs in patients with breast cancer. Nonliposuction endoscopic breast-conserving surgery is one of the safe and alternative surgical procedures for early breast cancer.
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Affiliation(s)
- Yinghui Liang
- 117889Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shuangta Xu
- 117889Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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3
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Huang S, Qiu P, Chen W, Zhang Y, Luo K, Li J. Modified radical mastectomy for anterior thoracic nerve and intercostobrachial nerve protection (case report). Gland Surg 2020; 9:463-466. [PMID: 32420275 PMCID: PMC7225455 DOI: 10.21037/gs.2020.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/17/2020] [Indexed: 11/06/2022]
Abstract
Modified breast cancer radical mastectomy is a more common operating method in breast surgery. Traditional modified radical mastectomy focuses on protecting the long thoracic nerve and thoracodorsal nerve while ignoring the protection of the anterior thoracic nerve and intercostobrachial nerve protection, which leads often to patients with upper medial arm numbness, acid swelling, pain, chest atrophy, and other problems. In the modified radical mastectomy of breast cancer, in this case, the author used an elaborative operation to protect the anterior thoracic nerve and intercostobrachial nerve and thoroughly dissected the third-level lymph nodes through the axillary approach.
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Affiliation(s)
- Shengchao Huang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Pu Qiu
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Weizhang Chen
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Yuanqi Zhang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Kangwei Luo
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Jianwen Li
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
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Chen Y, Xu J, Liang Y, Zeng X, Xu S. A challenging therapeutic method for breast cancer: Non-lipolytic endoscopic axillary surgery through periareolar incisions. Oncol Lett 2020; 19:4088-4092. [PMID: 32382347 PMCID: PMC7202305 DOI: 10.3892/ol.2020.11501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
Surgical treatment of breast cancer is becoming increasingly precise, less invasive, and more cosmetically pleasing. Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) remain the standard treatment methods for breast cancer. However, these methods still require incisions in the breasts or axilla. Mastoscopic axillary lymph node dissection (MALND) surgery, although first reported several years ago, has not been widely used as it involves lipolysis. Non-lipolytic mastoscopy may be more appealing; however, the lack of a cavity in the breast and the abundant fat and glands make this procedure challenging. In addition, incision of the trocar in the axilla has been shown to have no advantage over traditional breast-conserving surgery. The present study describes 16 cases of non-lipolytic endoscopic axillary surgery without incisions in the axilla.
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Affiliation(s)
- Yongqianq Chen
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Jianhua Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Yinghui Liang
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Xiaoshan Zeng
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Shuangta Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
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Video Endoscopic Inguinal Lymphadenectomy via 3-Incision Lateral Approach for Vulvar Cancers: Our Preliminary Outcome of 37 Cases. Int J Gynecol Cancer 2018; 26:1706-1711. [PMID: 27575632 DOI: 10.1097/igc.0000000000000816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to build a video endoscopic inguinal lymphadenectomy (VEIL) via the 3-incision superolateral inguinal approach and explore the feasibility and significance of this method for vulvar cancer. METHODS Thirty-seven patients with vulvar cancer who underwent VEIL via the 3-incision superolateral inguinal approach were enrolled and followed up. The number of excised lymph nodes, intraoperative complications, inguinal wound healing, and the prognosis were retrospectively analyzed. RESULTS The average number of excised lymph nodes per side is 8.8 ± 3.7 (4-18) among the 37 patients and after the new method was more mature, is 9.6 ± 3.6 among the 34 patients treated. Primary healing was found in 36 cases, whereas delayed healing occurred in 1 case complicated with diabetes. The lymph node-positive patients (6 cases) were supplemented with postoperative radiochemotherapy (RCT). All patients survived during the follow-up. Of the 2 recurrent patients, one patient who received surgery again and RCT survived without tumor. The other patient undergoing RCT survived with tumor. CONCLUSIONS Compared with open lymphadenectomy, VEIL via the 3-incision lateral approach provides a feasible, but more cosmetic, and promising minimally invasive modality in clinic for treating patients with vulvar cancer.
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Wu QF, Yu YH, Zhu X, Cui Y, Mo QG, Wei CY, Lin XJ, Liu XY, Xie WK, Gan S, Lei W. Development of video-assisted breast cancer surgery: Initial experience with a novel method for creating working space without prior liposuction. Mol Clin Oncol 2017; 7:32-38. [PMID: 28685071 PMCID: PMC5492639 DOI: 10.3892/mco.2017.1279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/13/2017] [Indexed: 11/06/2022] Open
Abstract
Endoscopic techniques are promising in breast surgery. In order to create working space, liposuction is widely used in video-assisted breast surgery (VABS). However, the use of liposuction is likely associated with side effects that may partly limit the application of VABS. Therefore, a new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. A total of 106 female patients underwent VABS, with special adaptation of the video-assisted surgical procedures previously described. Differing from other endoscopic surgery techniques, our adaptations of VABS included the selection of the working instruments, trocar placement, creation of working space, order of axillary lymph node dissection and method of mastectomy. The operative time was 50–180 min (mean, 85.5 min). The intraoperative blood loss ranged from 20 to 100 ml (mean, 48 ml). The mean lymph node number harvested was 11.5 (range, 6–31). No serious intra- or postoperative complications were recorded. There was no axillary tumor relapse, trocar site tumor implantation or upper limb edema. Without prior liposuction, our new technique of VABS reduced the blood loss volume, endoscopic surgery time, total volume of drainage fluid and, most importantly, the risk of port-site metastases. This new technique appears to have great clinical potential and good prospects for future endoscopic breast surgery development.
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Affiliation(s)
- Qian-Fu Wu
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
| | - Ying-Hua Yu
- Department of Breast Surgery of Guangxi Cancer Hospital and Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Xiao Zhu
- Department of Breast Surgery of Guangxi Cancer Hospital and Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Ying Cui
- Department of Experimental Research, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Qin-Guo Mo
- Department of Breast Surgery of Guangxi Cancer Hospital and Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Chang-Yuan Wei
- Department of Breast Surgery of Guangxi Cancer Hospital and Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Xue-Juan Lin
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
| | - Xue-Ying Liu
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
| | - Wei-Kang Xie
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
| | - Shui Gan
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
| | - Wei Lei
- Department of General Surgery of Guiping People's Hospital, Guiping, Guangxi 537200, P.R. China
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Immediate liposuction could shorten the time for endoscopic axillary lymphadenectomy in breast cancer patients. World J Surg Oncol 2017; 15:35. [PMID: 28137289 PMCID: PMC5282818 DOI: 10.1186/s12957-017-1106-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background Endoscopic axillary lymphadenectomy (EALND) was introduced to clinical work to reduce side effects of conventional axillary lymphadenectomy, while the lipolysis and liposuction of EALND made the process consume more time. The aim of the study was to determine whether immediate liposuction after tumescent solution injection to the axilla could shorten the total time of EALND. Methods Fifty-nine patients were enrolled in the study, 30 of them received EALND with traditional liposuction method (TLM), and the rest 29 patients received EALND with immediate liposuction method (ILM). The operation time, cosmetic result, drainage amount, and hospitalization time of the two groups were compared. Results The median EALND operation time of TLM group and ILM group were 68 and 46 min, respectively, the difference was significant (P < 0.05); the median cosmetic results of the two groups were 6.6 and 6.4, respectively; the median drainage amount of the two groups were 366 and 385 ml, respectively; the hospitalization time of the two groups were 15 and 16 days, respectively. For the last three measures, no significant difference was confirmed (P > 0.05). Conclusions Our work suggests immediate liposuction could shorten the endoscopic axillary lymphadenectomy process, and this method would not compromise the operation results. However, due to the limitations of the research, more work needs to be done to prove the availability and feasibility of immediate liposuction.
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8
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Functional and Therapeutic Indications of Liposuction: Personal Experience and Review of the Literature. Ann Plast Surg 2016; 75:231-45. [PMID: 25695452 DOI: 10.1097/sap.0000000000000055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.
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Owaki T, Kijima Y, Yoshinaka H, Hirata M, Okumura H, Ishigami S, Nerome Y, Takezaki T, Natsugoe S. Present status of endoscopic mastectomy for breast cancer. World J Clin Oncol 2015; 6:25-29. [PMID: 26078919 PMCID: PMC4462682 DOI: 10.5306/wjco.v6.i3.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 04/02/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopy is now being used for breast cancer surgery. Though it is used for mastectomy, lymph node dissection, and breast reconstruction, its prime use is for mastectomy. Because an incision can be placed inconspicuously in the axillary site, a relatively large incision can be created. A retractor with an endoscope, CO2, and an abrasion device with the endoscope are used for operation space security. It is extremely rare that an endoscope is used for lymph node dissection. For breast reconstruction, it may be used for latissimus muscle flap making, but an endoscope is rarely used for other reconstructions. Endoscopic mastectomy is limited to certain institutions and practiced hands, and it has not been significantly developed in breast cancer surgery. On the other hand, endoscopic surgery may be used widely in breast reconstruction. With respect to the spread of robotic surgery, many factors remain uncertain.
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Luo C, Guo W, Yang J, Sun Q, Wei W, Wu S, Fang S, Zeng Q, Zhao Z, Meng F, Huang X, Zhang X, Li R, Ma X, Luo C, Yang Y. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc 2012; 87:1153-61. [PMID: 23146657 PMCID: PMC3541933 DOI: 10.1016/j.mayocp.2012.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 07/02/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND). PATIENTS AND METHODS From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival. RESULTS The mean operative blood loss in the MALND group was less than in the CALND group (P<.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (P<.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (P=.001 at 6 months and P=.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (P=.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (P=.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (P=.95). CONCLUSION Compared with CALND, MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics.
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Affiliation(s)
- Chengyu Luo
- Fuxing Hospital, Capital Medical University, Beijing, China.
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Aponte-Rueda ME, Saade-Cárdenas RA, Navarrete-Aulestia S. Experimental model as training tool in endoscopic axillary dissection. MINIM INVASIV THER 2010; 19:61-8. [PMID: 20158409 DOI: 10.3109/13645701003642776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Endoscopic axillary lymphatic dissection is a viable surgical option, but has not been taken with great enthusiasm; several factors have accounted for this, including the lack of an effective experimental model to acquire skills and abilities. The aim of this study was to develop a training tool for endoscopic axillary dissection and to evaluate its applicability in a porcine model. Twenty endoscopic dissections of the axilla were performed in ten female pigs of four to six months by a single surgeon with blunt dissection and CO(2). A surgical workflow was divided into temporal operative phases. Time necessary to perform this action was compared throughout the study. The mean dissection time was 26 +/- 7 minutes. The axillary content was separated from the other anatomical elements under complete visualization (85%). Intraoperative complications occurred in two dissections (10%). Residual fibrofatty tissue was removed from the axilla in three dissections. This data defined a pig model for commencement of training in endoscopic axillary dissection in the laboratory. Bringing these core elements together led to the development of a model for acquiring advanced laparoscopic skills, which may be applicable to other endoscopic axillary procedures.
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Affiliation(s)
- María Eugenia Aponte-Rueda
- Endoscopic Surgery Unit, Service of Surgery, 2, Caracas University Hospital, University City, Caracas, Venezuela.
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Aponte-Rueda ME, Saade Cárdenas RA, Saade Aure MJ. Endoscopic axillary dissection: a systematic review of the literature. Breast 2009; 18:150-8. [PMID: 19493679 DOI: 10.1016/j.breast.2009.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 02/25/2009] [Accepted: 05/02/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To assess the feasibility, effectiveness and morbidity associated with Endoscopic Axillary Dissection. METHODS All studies published from 1990 until December 2008 in MEDLINE, LILACS, and COCHRANE. These studies were selected by two levels of criteria. Methodological designs, operating parameters, and postoperative follow-up were selected from each publication. RESULTS We extracted 49 citations and 12 were analyzed. The average age was 54.95+/-5.84 years. The surgical time was longer than the open procedure. The average number of extracted nodes exceeded ten. Technical problems and intra-operative complications had a rare occurrence. The recurrence was 0.5% (4/752). Two port metastases were registered. The methodological quality score average was 14.75. CONCLUSIONS This procedure meets the tumor control and staging requirements. It has shown similar results to the traditional procedure in terms of patient recovery, although the available evidence is not methodologically appropriate and does not justify its oncological safety.
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Affiliation(s)
- María Eugenia Aponte-Rueda
- Endoscopic Surgery Unit, Service of Surgery 2, Caracas University Hospital, Central University of Venezuela, University City, Los Chaguaramos, Caracas 1040, Venezuela.
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Chengyu L, Jian Z, Xiaoxin J, Hua L, Qi Y, Chen G. Experience of a large series of mastoscopic axillary lymph node dissection. J Surg Oncol 2008; 98:89-93. [PMID: 18484080 DOI: 10.1002/jso.21080] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Minimally invasive and functional therapy represents an inevitable trend in breast surgery. Improved visualization during mastoscopic axillary lymph node dissection (MALND) realizes a clear exposure of axillary anatomy, but it differs from a general laparoscopic operation. There are some challenges in technique itself which need to be noted. Detailed understanding of the elaborate operative technique, familiarity with the axillary anatomy and accurate adherence to procedure are main elements for successful MALND. Based on our experience of MALND, we have identified several points that are essential in ensuring successful MALND. MATERIALS AND METHODS Five hundred twenty-two patients underwent MALND. The special instruments, axillary anatomic landmarks and operative steps were illuminated. RESULTS Mean operative time was 39.2 min (range 20-156 min). Operative bleeding was minimal. A mean of 13.4 (range 4-38) lymph nodes were harvested. No intra or post-operation-related complication occurred. No axillary tumor relapse or trocar tumor implantation was identified during follow-up. CONCLUSIONS MALND can be performed with great convenience and safety with adherence to suitable procedures.
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Affiliation(s)
- Luo Chengyu
- Beijing Fuxing Hospital, Capital University of Medical Science, Beijing, China.
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14
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Prise en charge des lymphocèles après curage axillaire dans le cancer du sein. ACTA ACUST UNITED AC 2008; 36:130-135. [DOI: 10.1016/j.gyobfe.2007.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 07/15/2007] [Indexed: 10/22/2022]
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Gomatos IP, Filippakis G, Albanopoulos K, Zografos G, Leandros E, Bramis J, Konstadoulakis MM. Complete Endoscopic Axillary Lymph Node Dissection Without Liposuction for Breast Cancer: Initial Experience and Mid-term Outcome. Surg Laparosc Endosc Percutan Tech 2006; 16:232-6. [PMID: 16921302 DOI: 10.1097/00129689-200608000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To present our initial experience with complete endoscopic axillary lymph node dissection (EALND) in 4 breast cancer patients with respect to feasibility, safety, and clinical outcome. PATIENTS AND METHODS Between January 2003 and March 2004, 4 women consented to be treated with lumpectomy followed by complete (level I, II, and III) EALND without liposuction, at the Laparoendoscopic Unit of Athens Medical School. All 4 patients presented with a solitary breast cancer lesion smaller than 2 cm in diameter and a negative clinical and sonographic lymph node status (<1 cm). RESULTS All the operations were completed endoscopically in less than 70 minutes (44 to 69 min). The axillary lymph node harvest ranged between 12 and 21 nodes. No lymphedema, motor nerve damage, seroma formation, or wound complications were observed. Prolonged hospitalization, owing to persistent lymphorrhoea was required for 1 patient. During a mean follow-up of 21.3 months, 2 patients reported mild hypoesthesia-paresthesia along the upper medial part of the respective arm, whereas no tumor recurrences were documented. CONCLUSIONS Although partial EALND has not been established as the treatment of choice for axillary management, complete EALND seems to be a feasible and effective minimally invasive treatment modality, which could be safely applied in patients with positive sentinel node biopsy, treated in specialized centers.
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Affiliation(s)
- Ilias P Gomatos
- Laparoendoscopic Unit, 1st Department of Propaedeutic Surgery, Hippocration Hospital of Athens, Athens Medical School, 114 Q. Sofia Avenue, 11527 Athens, Greece
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Chengyu L, Yongqiao Z, Hua L, Xiaoxin J, Chen G, Jing L, Jian Z. A standardized surgical technique for mastoscopic axillary lymph node dissection. Surg Laparosc Endosc Percutan Tech 2005; 15:153-9. [PMID: 15956900 DOI: 10.1097/01.sle.0000166965.72145.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To standardize the surgical technique for mastoscopic axillary lymph node dissection (MALND). Mastoscopic lymph node dissection was performed consistently by a group of surgeons in 316 cases of breast cancer. The mean operation time was 46.7 minutes with minimal bleeding, and the median number of lymph nodes dissected at each operation was 17.0. There were no operative complications in any case, nor did trocar implantation or tumor diffusion occurring during the mean follow-up time of 15.1 months. MALND is distinctive and practicable in operative anatomy as well as safe and convenient. The location of critical anatomy such as the intercostobrachial nerve, lateral thoracic artery, medial thoracic nerve, and thoracoepigastric vein should be clearly identified to avoid damage to them, so that is the great advantage of MALND.
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Affiliation(s)
- Luo Chengyu
- Beijing Fuxing Hospital, Capital University of Medical Science, Beijing, PR China.
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Langer I, Kocher T, Guller U, Torhorst J, Oertli D, Harder F, Zuber M. Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients. Breast Cancer Res Treat 2005; 90:85-91. [PMID: 15770531 DOI: 10.1007/s10549-004-3268-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reports on long-term outcomes after endoscopic axillary lymph node dissection (ALND) of breast cancer patients are still lacking in the medical literature. The objective of this prospective study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND. METHODS Fifty-five breast cancer patients were prospectively enrolled, of whom 52 were available for follow-up with a median of 71.9 months (range 11-96). The following oncological and functional endpoints were evaluated during follow-up at several time points: occurrence of local, axillary and distant metastases, seroma or infection, shoulder mobility (range of motion), numbness, pain, presence of lymphoedema as well as restriction in activities of daily living. RESULTS In 52 patients endoscopic ALND of level I and II was successfully performed. Two port-site metastases (2/52, 4%) occurred, one of which in a patient with negative axillary lymph nodes. The same patient suffered from the only axillary recurrence (1/52, 2%). Three patients (3/52, 6%) developed lymphoedema. No other functional adverse events (shoulder mobility, pain, numbness, hypertrophic scar) were noticed at the end of the observation period. CONCLUSION The present investigation with long-term follow-up after endoscopic ALND--the first one in the literature--reveals minor morbidity, good functional and cosmetic results. In contrary to conventional surgery, the endoscopic procedure is associated with the occurrence of port-site metastases, not seen in the open approach. Axillary recurrences do not appear more frequently when compared with results after conventional ALND. In the meantime the less invasive sentinel lymph node (SLN) biopsy is the established standard technique in evaluating the axillary lymph node status.
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Affiliation(s)
- I Langer
- Department of Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
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Lumachi F, Burelli P, Basso SM, Iacobone M, Ermani M. Usefulness of Ultrasound Scissors in Reducing Serous Drainage after Axillary Dissection for Breast Cancer: A Prospective Randomized Clinical Study. Am Surg 2004. [DOI: 10.1177/000313480407000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Axillary dissection is usually associated with prolonged serous drainage that may result in several complications. We analyzed whether the use of ultrasound scissors may decrease the total amount of drainage from the axilla (AD) in patients requiring curative surgery for breast cancer. Seventy-six women (median age, 56 years; range, 32–73 years) with confirmed pT1–3, N0–1 breast cancer were prospectively randomly assigned to undergo mastectomy or breast-conserving surgery with axillary dissection by either using (group A) or not using (group B) ultrasound scissors. Overall, there was a linear relationship ( P < 0.05) between AD and both total number of the removed nodes and body mass index, whereas no correlation ( P = NS) was found with age and size of the tumor. Total AD was higher (492 ± 153 vs. 408 ± 136 mL, P = 0.013) in group B, whereas the postoperative hospital stay was shorter (2.4 ± 0.6 vs. 2.7 ± 0.7 days, P = NS) in group A. The three-way analysis of covariance using the number of total removed nodes as covariate showed that lymph node status, type of operation, and technique for axillary dissection significantly ( P < 0.05) correlated with AD. In conclusion, our initial study shows that the use of ultrasound scissors significantly reduced total AD in patients requiring axillary dissection and may shorten hospital stay.
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Affiliation(s)
- Franco Lumachi
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Paolo Burelli
- Unita Operativa di Chirurgia, Azienda Ospedaliera, Conegliano, Italy
| | - Stefano M.M. Basso
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Mario Ermani
- Section of Biostatistics, Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy
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Kuehn T, Santjohanser C, Grab D, Klauss W, Koretz K, Kreienberg R. Endoscopic axillary surgery in breast cancer. Br J Surg 2002; 88:698-703. [PMID: 11350444 DOI: 10.1046/j.1365-2168.2001.01751.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer.
Methods
Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed.
Results
The operating time ranged from 60 to 150 min. A mean 17 (range 10–28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility.
Conclusion
Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.
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Affiliation(s)
- T Kuehn
- Departments of Gynaecology and Obstetrics and Pathology, University of Ulm, Germany.
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