Breast Conserving Surgery and Sentinel Lymph Node Biopsy under Local Anesthesia for Breast Cancer

Abstract

Background: Breast conserving surgery and sentinel lymph node biopsy has become the standard operation for early breast cancer. This operation has been performed under local anesthesia for patients that would like short-term admission or for those not indicated for general anesthesia due to complications. This report presents the outcomes of breast conserving surgery and sentinel lymph node biopsy under local anesthesia. Patients and Methods: The study included 61 patients with breast cancer that were all definitely diagnosed before surgery. The indications were preoperatively diagnosed localized DCIS, invasive carcinoma measuring less than 3 cm in tumor diameter on ultrasound, and tumors with negative axillary lymph nodes. The surgical procedures included breast conserving surgery associated with sentinel lymph node navigation biopsy. Results: The surgery could be performed under local anesthesia in all 61 patients, and no patient was converted to general anesthesia. Four patients had sentinel lymph node metastasis. Surgical stumps were positive in 18 patients (29.5%). Ten Gy of boost irradiation of the tumor bed was added to the conventional breast irradiation for these patients. There were no serious complications associated with surgery. Conclusion: Breast conserving surgery and sentinel lymph node biopsy for early breast cancer can be performed safely under local anesthesia. This procedure contributes to shortening the length of hospitalization and thereby saving medical resources without deceasing the quality of treatment

Efficacy of Pectoral Nerve Block Type II for Breast-Conserving Surgery and Sentinel Lymph Node Biopsy: A Prospective Randomized Controlled Study

“…Breast-conserving surgery (BCS) and sentinel lymph node biopsy (SNB) are surgical methods designed to minimize intraoperative tissue injury, removing the cancer while leaving intact as much of the breast as possible. Moreover, because long-term survival rates are similar in patients undergoing BCS and radical mastectomy [ 1 ], the combination of BCS and SNB has become the standard treatment for patients with early-stage breast cancer [ 2 ].…”

Partial mastectomy using manual blunt dissection (MBD) in early breast cancer

“…Our surgical technique enables breast flap reconstruction without skin pulling to provide excellent cosmetic results. In the present study, general anesthesia was used, but MBD is thought to be possible under local anesthesia [ 23 ].…”

Ambulatory sentinel lymph node biopsy preceding neoadjuvant therapy in patients with operable breast cancer: a preliminary study

“…General anesthesia is therefore necessary for standard axillary lymph node dissection. SNB, however, can be carried out adequately and safely under local anesthesia, as described in the present study [ 14 - 18 ]. The existence and number of lymph node metastases are major prognostic factors [ 30 , 31 ], and obtaining an accurate diagnosis is mandatory for selecting patients who require additional systemic therapy after surgery.…”

“…For dye examination, 1.0 mL of 1% lidocaine (not containing epinephrine) was added to 4.0 mL of indocyanine green (5 mg/mL) solution and injected intracutaneously in the areola of the affected side (Figure 2 b). Approximately 10 min after injection, a skin incision (approximately 2 cm) was made in the axilla under local anesthesia with 0.5% to 1.0% lidocaine (containing 1:100,000 epinephrine) to identify the blue node [ 14 ]. A hand-held gamma probe was used to confirm the accumulation of radioactivity in the SN injected the day before SNB.…”

“…SNB can be performed safely and adequately under local anesthesia in the outpatient ambulatory setting, without hospitalization [ 14 - 20 ]. A pathological diagnosis can then be obtained from permanent preparations without the need for intraoperative evaluation of frozen sections, in which the latter process is associated with a 7% to 9% false-negative diagnosis rate [ 5 , 21 - 23 ].…”