Comparison of Classic and Endoscopic Lymphadenectomy for Staging Breast Cancer

doi:10.1016/S1074-3804(05)60238-1

The Journal of the American Association of Gynecologic Laparoscopists

Volume 10, Issue 1, February 2003, Pages 75-79

The Journal of the A...

https://doi.org/10.1016/S1074-3804(05)60238-1 Get rights and content

Abstract

Study Objective

To compare endoscopic and classic axillary lymphadenectomy staging of breast cancer with respect to operation-induced changes such as seroma formation, pain, neurologic sensations, lymphedema, infection, and reduction of shoulder-arm mobility.

Design

Prospective, randomized study (Canadian Task Force classification I).

Setting

University-affiliated hospital.

Patients

Eighty consecutive women with histopathologically confirmed invasive breast cancer who had clinically and sonographically negative axillary lymph nodes (<1 cm).

Intervention

Classic and endoscopic lymphadenectomies.

Measurements and Main Results

We attempted to obtain 10 axillary lymph nodes/patient. After 1, 3, 5, 7, 9, 42, and 84 days, clinical and ultrasonographic examinations were conducted to evaluate operation-induced changes. Short-term results showed that, with endoscopic technique, a representative number of axillary lymph nodes was removed, with reduced axillary infiltration and seroma induction, as well as less impaired shoulder-arm mobility. During the first month, postoperative infection, lymphedema, and neurologic complaints were comparable in both groups, with more stretching pain in the classic group and predominantly paresthesia in the endoscopic group. After 3 months no differences in postoperative complications were detected.

Conclusion

Endoscopic axillary lymphadenectomy avoids short-term reduction of shoulder-arm mobility. Long-term studies are necessary to prove if this technique is as safe as the classic procedure with regard to local axillary recurrence. If so, endoscopy could become the method of choice for staging breast cancer in women with clinically negative lymph nodes.

Section snippets

Materials And Methods

We compared endoscopic and conventional lymph node dissection in 80 women with primary breast cancer to determine advantages and limitations of both procedures especially with regard to postoperative changes. Inclusion criteria were histopathologic confirmation as well as negative clinical and sonographic lymph node status (<1 cm). Consecutive patients were randomized into one of two groups in order of enrollment. Women in group A (mean age 64.9 yrs, range 41–92 yrs) underwent conventional

Results

Operating time was 36 minutes (range 19–66 min) in group A and 62 minutes (range 42–126 min) in group B. Operating time after 50 patients (learning curve) was 36 minutes (range 24–85 min)/10 extirpated nodes starting with insertion of the optic and ending with skin closure.

Analysis of tumor stage in both groups showed comparable results (Table 1). In group A the mean number of collected lymph nodes from levels 1 and 2 was 12 (range 1–22). In group B the number was 11 (4–21).

On three-dimensional

Discussion

In this comparison of endoscopic and conventional axillary lymphadenectomy we found differences in short-term side effects possibly due to better preservation of fine axillary structures by the former method. The endoscopic technique caused less shoulder stiffness. Neurologic complaints such as paresthesia were more common in group B, however, but more shoulder-arm pain was seen in group A. These side effects were documented within the first 6 postoperative weeks. After 3 months there were no

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Original ArticlesComparison of Classic and Endoscopic Lymphadenectomy for Staging Breast Cancer