17-Year Follow-Up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

Abstract

Background: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND).Methods：From January 1, 2003 to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection). 996 eligible patients were enrolled.Results：The final cohort of 996 patients was followed for an average of 198 months. The events other than death differed significantly between the two cohorts（p=0.0311） (46.3% in MALND and 53.2% in CALND, respectively). The sum of the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups (p=.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p= .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year.Conclusions：The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.