A Standardized Surgical Technique for Mastoscopic Axillary Lymph Node Dissection

Abstract

To standardize the surgical technique for mastoscopic axillary lymph node dissection (MALND). Mastoscopic lymph node dissection was performed consistently by a group of surgeons in 316 cases of breast cancer. The mean operation time was 46.7 minutes with minimal bleeding, and the median number of lymph nodes dissected at each operation was 17.0. There were no operative complications in any case, nor did trocar implantation or tumor diffusion occurring during the mean follow-up time of 15.1 months. MALND is distinctive and practicable in operative anatomy as well as safe and convenient. The location of critical anatomy such as the intercostobrachial nerve, lateral thoracic artery, medial thoracic nerve, and thoracoepigastric vein should be clearly identified to avoid damage to them, so that is the great advantage of MALND.

Comparison of Mastoscopic and Conventional Axillary Lymph Node Dissection in Breast Cancer: Long-term Results From a Randomized, Multicenter Trial

“…Nevertheless, with the improvement in the MALND technique, including the endoscope reselection, operation standardization, and management of the operative field, no axillary relapse or trocar implantation has been reported in larger series and nonrandomized studies in recent years. 9,18,34,39 Our trial found no port-site metastasis in the MALND group. In addition, the axillary recurrence rate is smaller in both our study groups (1.0% [5/500] in the CALND group and 1.2% [6/496] in the MALND group).…”

“…The MALND operation was performed according to the method reported previously. 9,18,27 Patients were treated with systemic therapy and radiation therapy according to the same standard institutional protocols (National Comprehensive Cancer Network Breast Cancer Practice Guideline).…”

“…If the sentinel lymph node biopsy result is positive, a CALND must be performed, even though its timing and accuracy in patients who may have received neoadjuvant chemotherapy for breast cancer remain controversial. [9][10][11] In recent years, these inherent limitations of CALND have provoked interest in finding new surgical approaches that can reduce complications, preserve better arm function, and improve the postoperative appearance of the chest and axilla without compromising the thoroughness of ALND. Mastoscopic axillary lymph node dissection (MALND) is a new surgical approach to treating breast cancer.…”

Experience of a large series of mastoscopic axillary lymph node dissection

“…Its long-period complications such as the functional disability, severe pain, edema and movability-related complications of upper limb decreased obviously [4,21,22]. The longest follow-up period in our MALND cases has been over 4 years.…”

“…It maximizes the benefits of the minimally invasive approach; improved functionality, improved cosmesis and improves the image of CALND greatly, with the benefits of improved safety and tumor dissection. MALND has been gradually adopted in multiple medical centers worldwide and welcomed by both surgeons and patients [1][2][3][4]. It has great clinical potential and good prospects for future development.…”