Mastoscopic axillary lymph node dissection ‘preferred choice’

Long-term study findings support the use of mastoscopic axillary lymph node dissection (MALND) for women with operable breast cancer.

Compared with patients who underwent conventional axillary lymph node dissection (CALND), women assigned to receive the endoscopic technique lost significantly less blood during surgery (12.82 vs 128.29 mL), report Chengyu Lao (Fuxing Hospital, Capital Medical University, Beijing, China) and co-authors.

Moreover, women who underwent MALND reported a significantly lower rate of axillary pain, numbness or paresthesias, and arm swelling at both 6 and 24 months after their procedure compared with CALND patients. MALND also gave a better aesthetic appearance, as judged by the patients.

In addition, secondary analyses demonstrated that MALND and CALND patients did not significantly differ with regard to disease-free survival (64.5 vs 60.8%) or overall survival (81.7 vs 78.6%) over a median 63 months of follow up.

However, there was a small significant reduction in the rate of distant metastases in MALND patients compared with those who underwent CALND (22.8 vs 28.2%).

"This is the most significant finding of the study," commented Luo in a press release

"While there is not as yet any significant difference in survival, longer term follow-up (e.g., 10 years and 20 years) is still needed to make a definitive conclusion. This may suggest that the axillary operation should be done before the breast operation even in conventional surgery."

Writing in the Proceedings of the Mayo Clinic, the researchers conclude: "MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics. Therefore, MALND should be the preferred approach for breast cancer surgery."

The study included 500 women randomly assigned to undergo CALND and 496 women assigned to receive MALND between 2003 and 2005 for breast cancer. None of the patients had axillary lymph node disease on preoperative examination.

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