Authors: Chengyu Luo, Changsheng Wei, Wenbin Guo, Jie Yang, Qiuru Sun, Wei Wei, Shuhua Wu, Shubing Fang, Qingliang Zeng, Zhensheng Zhao, Fanjie Meng, Xuandong Huang, Xianlan Zhang, Ruihua Li, Xiufeng Ma, Chaoying Luo & Yun Yang
Abstract
Introduction
Longer follow-up was necessary to determine the exact value of mastoscopic axillary lymph node dissection (MALND).
Methods
From January 1, 2003, to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection); 996 eligible patients were enrolled.
Results
The final cohort of 996 patients was followed for an average of 198 months. Events other than death differed significantly between the two cohorts (p = 0.0311; 46.3% in MALND and 53.2% in CALND, respectively). The sum of events other than death and deaths from other causes was much higher in the CALND (59.6%) than MALND (53.4%) group (p = 0.0494). The 17-year disease-free survival DFS rates were 36.7% for the MALND and 33.6% for the CALND group, respectively. There was a significant difference between the groups (p = 0.0306). Overall survival (OS) rates were 53.2% after MALND and 46.0% after CALND (p = 0.0119). MALND patients had much less axillary pain (p = 0.0000), numbness or paresthesia (p = 0.0000), arm mobility (p = 0.0000) and arm swelling on the operated side (p = 0.0000). Aesthetic appearance of the axilla was much better in the MALND than CALND group (p = 0.0000) at an average follow-up of 17 years.
Conclusions
The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.
Trial Registration Information
The comparison of long-term outcomes of mastoscopic and conventional axillary lymph node dissection in breast cancer: a multicenter randomized control trial. ChiCTR-TRC-11001477, CHiCTR. First registration 08/14/2011.
Key Summary Points |
Why carry out this study?Some inherent shortcomings of conventional axillary lymph node dissection (CALND) for the treatment of breast cancer seriously affect the quality of life of patients with breast cancer. Endoscopy-assisted breast cancer surgery has been developed for nearly all breast operations for about 30 years. This technique produces good clinical results. In 2003, we initiated a multicenter randomized clinical trial in breast cancer patients comparing mastoscopic axillary lymph node dissection (MALND) to CALND. We now present information from an average 17-year post-randomization follow-up. |
What was learned from the study?The use of MALND in breast cancer surgery not only decreases relapse and arm complications but also improves long-term survival of patients. MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed. |