A pilot clinical study comparing endoscopic surgery with open surgurey in internal mammary lymph chain of breast cancer

doi:10.3877/cma.j.issn.1674-0807.2011.02.009

Abstract

Abstract:

Objective

To compare the clinical efficacy between modified radical mastectomy plus endoscopic resection of internal mammary lymph chain and extended or modified radical mastectomy in order to find more suitable surgery for breast cancer patients with high risk of internal mammary lymph node metastasis.

Methods

Ninety-seven breast cancer patients with high risk of internal mammary lymph node metastases were collected in the Breast Disease Center of Southwest Hospital from June 2004 to November 2010.Among them,50 patients underwent modified radical mastectomy plus endoscopic resection of internal mammary lymph chain (the endoscopic surgery group),and 47 patients underwent extended or modified radical mastectomy (the open surgery group).The operative duration,the volume of intraoperative blood loss,the number of internal mammary lymph nodes resected,postoperative drainage time,postoperative recovery time,postoperative pain score and postoperative complications were recorded and compared between the two groups. Statistical analysis was performed using t test or Mann-Whitney U test for quantitative data and chi square test for qualitative data.

Results

Operations were completed successfully in all the 97 patients,and no organ damage,postoperative bleeding or other serious complications were found. The 72 hour pain scores after surgery in the endoscopic surgery group were lower than in the open surgery group (Z=2.26,P=0.02). There were no statistically significant differences in the average operation duration,the mean blood loss,the average number of internal mammary lymph nodes resected,postoperative drainage time,postoperative recovery time,postoperative 24-hour pain score and complications between the two groups(P＞0.05). The follow-up of 6-15 months (mean 12 months) showed no recurrence,distant metastasis or death in both groups.

Conclusion

Endoscopic resection of internal mammary lymph chain after modified radical mastectomy is safe and feasible,with less invasion and similar therapeutic effect with the open surgery.

Key words: breast neoplasms, endoscopic resection of internal mammary lymph chain, xtended radical mastectomy, clinical efficacy

Zai-hong ZHANG, Xin-hu YANG, Yi ZHANG, Ling-jun FAN, Fan ZHANG, Li CHEN, Yan ZHOU, Han GAO, Jia MING, Jun JIANG. A pilot clinical study comparing endoscopic surgery with open surgurey in internal mammary lymph chain of breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2011, 05(02): 180-188.

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Figures/Tables 6

References 21

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组别	临床分期			肿瘤位置			病理类型		雌激素受体		孕激素受体		人表皮生长因子受体
组别	Ⅱ期	Ⅲ期	Ⅳ期	内侧	中央	外侧	浸润性导管癌	其他类型癌	阳性	阴性	阳性	阴性	阳性	阴性
腔镜组(n=50)	14	32	4	10	20	20	43	7	26	24	30	20	29	21
开放组(n=47)	8	37	2	15	15	17	40	7	21	26	22	25	23	24
χ²值	2.58			1.86			0.02		0.52		1.70		0.80
P值	0.28			0.39			0.90		0.47		0.19		0.37

组别	临床分期			肿瘤位置			病理类型		雌激素受体		孕激素受体		人表皮生长因子受体
组别	Ⅱ期	Ⅲ期	Ⅳ期	内侧	中央	外侧	浸润性导管癌	其他类型癌	阳性	阴性	阳性	阴性	阳性	阴性
腔镜组(n=50)	14	32	4	10	20	20	43	7	26	24	30	20	29	21
开放组(n=47)	8	37	2	15	15	17	40	7	21	26	22	25	23	24
χ²值	2.58			1.86			0.02		0.52		1.70		0.80
P值	0.28			0.39			0.90		0.47		0.19		0.37

组别	手术时间(min)	术中出血量[M(QR),ml]	清除内乳淋巴结数[M(QR),枚]	术后引流时间(d)	术后恢复时间(d)	术后疼痛评分[M(QR),分]		并发症(例)
组别	手术时间(min)	术中出血量[M(QR),ml]	清除内乳淋巴结数[M(QR),枚]	术后引流时间(d)	术后恢复时间(d)	24 h	72 h	并发症(例)
腔镜组(n=50)	357.68±95.79	300(200)	3(2)	7.32±1.90	8.57±1.87	6(2)	4(2)	8
开放组(n=47)	335.09±117.09	300(150)	2(3)	7.66±1.84	8.49±2.08	6(1)	4(1)	10
统计量	1.02^a	1.15^b	1.82^b	0.89^a	0.22^a	0.01^b	2.26^b	0.45^c
P值	0.30	0.25	0.06	0.38	0.83	0.83	0.02	0.50

组别	手术时间(min)	术中出血量[M(QR),ml]	清除内乳淋巴结数[M(QR),枚]	术后引流时间(d)	术后恢复时间(d)	术后疼痛评分[M(QR),分]		并发症(例)
组别	手术时间(min)	术中出血量[M(QR),ml]	清除内乳淋巴结数[M(QR),枚]	术后引流时间(d)	术后恢复时间(d)	24 h	72 h	并发症(例)
腔镜组(n=50)	357.68±95.79	300(200)	3(2)	7.32±1.90	8.57±1.87	6(2)	4(2)	8
开放组(n=47)	335.09±117.09	300(150)	2(3)	7.66±1.84	8.49±2.08	6(1)	4(1)	10
统计量	1.02^a	1.15^b	1.82^b	0.89^a	0.22^a	0.01^b	2.26^b	0.45^c
P值	0.30	0.25	0.06	0.38	0.83	0.83	0.02	0.50

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