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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: 1.0] [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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2
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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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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: 0.5] [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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4
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Fang J, Ma L, Zhang YH, Yang ZJ, Yu Y, Cao XC. Endoscopic sentinel lymph node biopsy and endoscopic axillary lymphadenectomy without liposuction in patients with early stage breast cancer. Surg Oncol 2017; 26:338-344. [PMID: 29113649 DOI: 10.1016/j.suronc.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/25/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our purpose was to present a new method of endoscopic sentinel lymph node biopsy (ESLNB) and endoscopic axillary lymphadenectomy (EALND) without liposuction for treating early-stage breast cancer, and compare results with traditional open dissection. METHODS The medical records of patients with early-stage breast cancer who underwent EALND/ESLNB without liposuction or traditional open dissection between March 2015 and September 2016 were retrospectively reviewed. Outcomes between the 2 groups were compared. RESULTS A total 65 patients with a mean age of 41.2 ± 9.3 years (range, 23-60 years) were included. Thirty-three patients underwent traditional open lymph node dissection and 32 patients underwent endoscopic treatment. The 2 groups were similar with respect to age, body mass index (BMI), menopausal status, tumor location, and tumor disease stage (all, p > 0.05). The mean operating time was significantly higher in the endoscopic group (91.2 vs. 75.2 min, p = 0.022), while the mean blood loss was significantly lower (28.7 vs. 37.0 ml, p = 0.034). The mean number of SLNs harvested in the open (2.4 ± 1.6) and the endoscopic (2.3 ± 1.4) groups were not different (p = 0.829), with a sentinel lymph node retrieval rate of 80%. The mean number of axillary lymph nodes harvested in the open (13.8 ± 3.3) and the endoscopic (13.3 ± 3.1) groups were not different (p = 0.457). Scars were minimal in the endoscopic group. CONCLUSION ESLNB and EALND without liposuction for early-stage breast cancer is feasible, has a low complication rate, a lymph node harvest rate similar to that of open dissection, and has good cosmetic results. Future studies, however, are required to evaluate oncological outcomes.
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Affiliation(s)
- Jing Fang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China; Department of Thyroid and Breast Surgery, The Anqing Hospital Affiliated to Anhui Medical University Anqing, Anhui 246003, China
| | - Li Ma
- Department of Thyroid and Breast Surgery, The Anqing Hospital Affiliated to Anhui Medical University Anqing, Anhui 246003, China
| | - Yong-Hui Zhang
- Department of Breast Surgery, Peking University International Hospital, Beijing, PR China
| | - Zheng-Jun Yang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Xu-Chen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.
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5
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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: 11] [Impact Index Per Article: 1.6] [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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6
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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: 3] [Impact Index Per Article: 0.4] [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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7
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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: 1.3] [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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8
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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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9
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Woo HD, Han SW, Son DM, Kim SY, Lim CW, Lee MH. Endoscopic Sentinel Lymph Node Biopsy in Breast Cancer Surgery: Feasibility and Accuracy of the Combined Radioisotope and Blue Dye. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.1.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hee Doo Woo
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sun Wook Han
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Doo Min Son
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chul Wan Lim
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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10
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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: 0.9] [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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11
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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: 0.6] [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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12
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Hussein O, El-Nahhas W, El-Saed A, Denewer A. Video-assisted axillary surgery for cancer: Non-randomized comparison with conventional techniques. Breast 2007; 16:513-9. [PMID: 17532217 DOI: 10.1016/j.breast.2007.03.005] [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] [Received: 01/02/2007] [Revised: 03/08/2007] [Accepted: 03/25/2007] [Indexed: 01/22/2023] Open
Abstract
Endoscopic techniques have been introduced in most of surgical disciplines including surgery for breast cancer. However, there is shortage of evidence-based guidelines and oncological outcome data. We present a controlled trial of endoscopic axillary surgery for breast cancer with mid-term oncologic results. Fifty cases of axilloscopy for sentinel node biopsy, axillary sampling or full axillary dissection were included. Sentinel node biopsy was accomplished with the blue dye technique. Full axillary dissection was performed with a three-port approach with gas insufflation without liposuction. Endoscopic axillary dissection significantly lowered duration of drainage and operative blood loss. Lymph node harvest with endoscopic approach was significantly lower than with open procedure. One case developed axillary recurrence. Endoscopic sentinel node biopsy yielded identification rate of 80%. Current data do not justify the oncological safety of resectional endoscopic procedures. Endoscopically assisted axillary cancer surgery is technically feasible. The technique is valuable to maximize utility of blue dye method for sentinel lymphadenectomy in areas with no access to radio-guided surgery.
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Affiliation(s)
- Osama Hussein
- Department of Surgery, Mansoura University Cancer Center, Mansoura University, Mansoura 35516, Egypt.
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13
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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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14
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Tamaki Y, Tsukamoto F, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S. Overview: video-assisted breast surgery. Biomed Pharmacother 2003; 56 Suppl 1:187s-191s. [PMID: 12487279 DOI: 10.1016/s0753-3322(02)00206-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Since 1992, video-assisted surgery for the breast has been developed mainly in the field of plastic surgery, notably in breast augmentation surgery. Today, video-assisted surgery, indicating partial or total endoscopic surgery, can be performed for the treatment of both benign and malignant breast tumors to improve the cosmetic outcome. Although, in some respects, this kind of surgery for malignant tumors is still experimental, it is feasible enough for clinical use, and is expected to become one of the standard operations for breast cancer.
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Affiliation(s)
- Yasuhiro Tamaki
- Department of Surgical Oncology, Graduate School of Medicine, Osaka University, 2-2-E10, Yamadaoka, Suita, Osaka 565-0871, Japan.
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McGreevy JM, Cannon MJ, Grissom CB. Minimally invasive lymphatic mapping using fluorescently labeled vitamin B12. J Surg Res 2003; 111:38-44. [PMID: 12842446 DOI: 10.1016/s0022-4804(03)00093-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND We examined the usefulness of a new agent in the mapping and dissection of inguinal lymph nodes in the pig. Cy5-cobalamin bioconjugate is blue under visible light and fluoresces brilliant red with laser stimulation. The wavelength of the emitted red light is sufficiently long that it is visible through blood, subcutaneous fat, and fascia. Currently available surgical techniques of minimally invasive dissection are well suited for using fluorescent detection in a dark operating field with minimal modification of an existing Hopkins surgical telescope. MATERIALS AND METHODS We tested this concept in the live post-adolescent, female, nonlactating pig (30 kg). We insufflated the subcutaneous tissue over the groin and inserted three ports (1 x 10 mm and 2 x 5 mm) for dissection. We injected the Cy5-cobalamin bioconjugate in a dermal location on the hind limb. A HeNe laser stimulated the CobalaFluor in the lymphatics and the emitted fluorescence passed through a holographic notch filter to a three-chip camera. RESULTS Under white light, the lymphatic trunks and the sentinel node were visualized within minutes of injection. Both the lymphatic trunks and the node fluoresced bright red under stimulation with red laser light. CONCLUSIONS These preliminary studies establish the potential usefulness of this new agent in lymphatic mapping. This novel technology might be useful in visualizing cancers that spread to regional lymph nodes. This technique has the potential to map the lymphatic drainage and to identify the presence of malignant cells in that drainage with currently available minimally invasive technology.
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Affiliation(s)
- James M McGreevy
- Department of Surgery, University of Utah, Salt Lake City, Utah 84132, USA.
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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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Michel SCA, Keller TM, Fröhlich JM, Fink D, Caduff R, Seifert B, Marincek B, Kubik-Huch RA. Preoperative breast cancer staging: MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement. Radiology 2002; 225:527-36. [PMID: 12409591 DOI: 10.1148/radiol.2252011605] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate magnetic resonance (MR) imaging with ultrasmall superparamagnetic iron oxide (USPIO) enhancement for preoperative axillary lymph node staging in patients with breast cancer by using histopathologic findings as the standard of reference. MATERIALS AND METHODS MR imaging was performed with a 1.5-T system within 24-36 hours after the start of intravenous slow-drip infusion of USPIO in 20 patients with breast cancer who were scheduled for surgery, followed by gadolinium-enhanced MR imaging. Lymph nodes were staged prospectively by using newly established criteria, and results were correlated with histologic findings. RESULTS In two patients, preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given; both patients were excluded from statistical analysis. Results of axillary staging with USPIO-enhanced MR imaging were true-positive in nine, true-negative in seven, false-positive in zero, and false-negative in two of 18 patients (sensitivity, 82%; specificity, 100%; positive predictive value, 100%; second reader, kappa = 1.0). Four hundred five lymph nodes were detected with MR imaging. For first and second readers, respectively, lymph node-based sensitivity was 83% and 73% and specificity was 96% and 97% (kappa = 0.68). USPIO as the intravascular contrast agent could not replace gadolinium for assessment of the primary tumor; however, no clinically relevant interaction was seen. Thus, an integrated imaging approach was feasible in all patients. CONCLUSION USPIO-enhanced MR imaging has the potential to become an adjunct to conventional MR imaging of the breast for preoperative assessment of axillary lymph nodes in patients with breast cancer.
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Affiliation(s)
- Sven C A Michel
- Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland
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Acea-Nebril B, Berta CB, Sobrido M. Eficacia y seguridad de la biopsia selectiva del ganglio centinela en enfermas con cáncer de mama. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72002-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ganglio centinela: ¿linfadenectomía selectiva del futuro? Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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