Langer I, Kocher T, Guller U, Torhorst J, Oertli D, Harder F, Zuber M
Department of Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland.
Breast Cancer Res Treat. 2005 Mar;90(1):85-91. doi: 10.1007/s10549-004-3268-6.
Reports on long-term outcomes after endoscopic axillary lymph node dissection (ALND) of breast cancer patients are still lacking in the medical literature. The objective of this prospective study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND.
Fifty-five breast cancer patients were prospectively enrolled, of whom 52 were available for follow-up with a median of 71.9 months (range 11-96). The following oncological and functional endpoints were evaluated during follow-up at several time points: occurrence of local, axillary and distant metastases, seroma or infection, shoulder mobility (range of motion), numbness, pain, presence of lymphoedema as well as restriction in activities of daily living.
In 52 patients endoscopic ALND of level I and II was successfully performed. Two port-site metastases (2/52, 4%) occurred, one of which in a patient with negative axillary lymph nodes. The same patient suffered from the only axillary recurrence (1/52, 2%). Three patients (3/52, 6%) developed lymphoedema. No other functional adverse events (shoulder mobility, pain, numbness, hypertrophic scar) were noticed at the end of the observation period.
The present investigation with long-term follow-up after endoscopic ALND--the first one in the literature--reveals minor morbidity, good functional and cosmetic results. In contrary to conventional surgery, the endoscopic procedure is associated with the occurrence of port-site metastases, not seen in the open approach. Axillary recurrences do not appear more frequently when compared with results after conventional ALND. In the meantime the less invasive sentinel lymph node (SLN) biopsy is the established standard technique in evaluating the axillary lymph node status.
医学文献中仍缺乏关于乳腺癌患者内镜下腋窝淋巴结清扫术（ALND）后长期预后的报道。本前瞻性研究的目的是评估乳腺癌患者内镜下ALND后的肿瘤学和功能预后。
前瞻性纳入55例乳腺癌患者，其中52例可供随访，中位随访时间为71.9个月（范围11 - 96个月）。在随访的几个时间点评估以下肿瘤学和功能终点：局部、腋窝和远处转移的发生情况、血清肿或感染、肩部活动度（活动范围）、麻木、疼痛、淋巴水肿的存在以及日常生活活动受限情况。
52例患者成功进行了I级和II级内镜下ALND。发生了2例切口种植转移（2/52，4%），其中1例发生在腋窝淋巴结阴性的患者中。同一患者发生了唯一的腋窝复发（1/52，2%）。3例患者（3/52，6%）出现了淋巴水肿。在观察期结束时，未发现其他功能不良事件（肩部活动度、疼痛、麻木、肥厚性瘢痕）。
本项对内镜下ALND进行长期随访的研究——文献中的首例研究——显示并发症发生率低，功能和美容效果良好。与传统手术相反，内镜手术与切口种植转移的发生有关，而在开放手术中未见此情况。与传统ALND的结果相比，腋窝复发并未更频繁出现。同时，创伤较小的前哨淋巴结（SLN）活检是评估腋窝淋巴结状态的既定标准技术。
