Mastoscopic axillary lymph node dissection (MALND), en endoscopic technique to determine if breast cancer has spread to the adjoining lymph nodes, can reduce the complications associated with the conventional surgical approach to axillary lymph node dissection.

In conjunction with lumpectomy or mastectomy, axillary lymph node dissection is used to determine if the breast cancer has spread to the adjoining lymph nodes. The conventional surgical approach leaves an unattractive surgical scar, can restrict range of motion in the shoulder joint, and can stimulate tumor cell metastases through the squeezing and pulling of the tumor during the breast operation.

This study randomly assigned 1,027 patients with operable breast cancer to either a breast operation and axillary lymph node dissection by conventional surgical means (CALND) or MALND first and then conventional breast surgery. Both groups of patients were treated postoperatively with systemic therapy and radiation therapy. The average follow-up was 63 months.

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The MALND group had a lower average blood loss than the CALND group. Operative time was the same for both groups. The patients who underwent MALND had less pain, numbness, paresthesias, and arm swelling. The aesthetic appearance of the axilla was much better for the MALDN group than the CALND group. The two groups had no significant difference in disease-free survival or overall survival.

The distant metastasis rate did have a significant difference that favored the MALDN group. The lead investigator, Chengyu Luo, MD, of Fuxing Hospital, Capital Medical University, Beijing, China, explained, “This is the most significant finding of the study,” says Dr. Luo. “While there is not as yet any significant difference in survival, longer term follow-up (eg, 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.”

This study was published in Mayo Clinic Proceedings (2012; doi:10.1016/j.mayocp.2012.07.022).