Study objective: To compare endoscopic and classic axillary lymphadenectomy staging of breast cancer with respect to operation-induced changes such as seroma formation, pain, neurologic sensations, lymphedema, infection, and reduction of shoulder-arm mobility.
Design: Prospective, randomized study (Canadian Task Force classification I).
Setting: University-affiliated hospital.
Patients: Eighty consecutive women with histopathologically confirmed invasive breast cancer who had clinically and sonographically negative axillary lymph nodes (<1 cm).
Intervention: Classic and endoscopic lymphadenectomies.
Measurements and main results: We attempted to obtain 10 axillary lymph nodes/patient. After 1, 3, 5, 7, 9, 42, and 84 days, clinical and ultrasonographic examinations were conducted to evaluate operation-induced changes. Short-term results showed that, with endoscopic technique, a representative number of axillary lymph nodes was removed, with reduced axillary infiltration and seroma induction, as well as less impaired shoulder-arm mobility. During the first month, postoperative infection, lymphedema, and neurologic complaints were comparable in both groups, with more stretching pain in the classic group and predominantly paresthesia in the endoscopic group. After 3 months no differences in postoperative complications were detected.
Conclusions: Endoscopic axillary lymphadenectomy avoids short-term reduction of shoulder-arm mobility. Long-term studies are necessary to prove if this technique is as safe as the classic procedure with regard to local axillary recurrence. If so, endoscopy could become the method of choice for staging breast cancer in women with clinically negative lymph nodes.