Trans-peri-areolar breast conservative surgery followed by endoscopic axillary lymph node dissection: a novel surgical option

Aim/Background

Endoscopic surgery is a standard in most surgical fields but not widely applied in breast cancer due to limited benefits.We report the cosmetic outcomes and complications of a new breast conservative surgery (EBCS) procedure, which consists in using a 3cm peri-areolar incision to perform lumpectomy followed by endoscopic axillary lymph node dissection without liposuction.

Methods

From Nov 2013 to May 2015, 53 patients diagnosed with early stage breast cancer were categorized into the conventional breast conservative surgical (CBCS, 28 patients) and EBCS group (25 patients). Indications for EBCS were 1.tumor/breast ratio below 20% 2. no distant metastasis 3. Tumor mass not located in the lower-inferior quadrant. Inform consents were obtained from all patients. Number of lymph nodes harvested, tumor size, intra-operative bleeding, drainage volume, pain score (10scale survey) were collected. The breast symmetrical score (BSS,direct distance from nipple to fovea jugularis,midclavicular, midsternal, inframammary fold and anterior axillary line of both breast was measured and distance difference ratio of operated to contralateral site was calculated. BSS is the sum of each absolute value of distance difference ratio) and patient satisfaction (4scale survey) were used to evaluate cosmetic outcomes.

Results

There was no statistical difference in intra-operative bleeding, drainage volume, average tumor size and lymph metastasis. An increased number of harvested lymph nodes was observed in the EBCS. The pain score meanwhile BSS was significantly superior in the EBCS group. Patient satisfaction survey reported a positive feedback.

Cosmetic outcomes and complications

Conclusions

Evaluation of long-term survival, complication rates and cosmetic results are mandatory for further estimations. EBCS patients displayed a significantly superior outcome.EBCS may be a feasible surgical alternative with minimal invasiveness, suitable to patients demanding excellent cosmetic outcome.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.