Early experience of robotic axillary lymph node dissection in patients with node-positive breast cancer

Abstract

Background Robotic surgical systems enable surgeons to perform precise movement in the surgical field using high-resolution 3D vision and flexible robotic instruments. We aimed to evaluate the feasibility and safety of performing axillary lymph node dissection using a robotic surgical system in patients with node-positive breast cancer. Methods Thirty-two women with breast cancer who underwent robot-assisted nipple-sparing mastectomy (RNSM) and level I/II axillary lymph node dissection were analyzed. Patients were divided into two groups: RNSM with conventional axillary lymph node dissection (CALND) vs. RNSM with robotic axillary lymph node dissection (RALND). Clinicopathological features and surgical outcomes were analyzed. ResultsThe median age of the patients was 44 (range 20-59) years. Eleven patients underwent RALND. None of the clinicopathologic features differed between the two groups. There were no statistically significant differences in surgical outcomes, except for the final incision size, between the two groups. The proportion of cases with an incision ≤ 40 mm was 63.6% in the RALND group and 36.4% in the CALND group (p = 0.020). Conclusion RALND can be safely performed in RNSM. RNSM with RALND is comparable to RNSM with CALND in terms of early surgical outcomes. The incision size can be reduced when using RALND.

An exploratory study of whether axillary lymph node dissection can be avoided in breast cancer patients with positive lymph nodes

“…In recent years, there have been ongoing debates over which breast cancer patients with positive axillary nodes can avoid ALND without compromising their survival chances. In comparison with ALND, SLNB substantially improves the quality of life and reduces complications, making it a gold standard method for axillary surgeries of patients with early breast tumors ( 8 , 16 - 18 ). Our study analyzed data on 21,942 breast cancer patients from 2000 to 2017 in the SEER database.…”

“…Patients with positive axillary lymph nodes commonly receive ALND, which maintains local lymph node control. However, ALND is notorious for its high risk of postoperative complications, such as lymphedema and decreased upper extremity motion, which have a significant impact on quality of life in patients with breast cancer ( 6 - 8 ). Determining which patients with positive axillary lymph nodes can receive SLNB alone instead of ALND has always been a research hotspot in the field of breast cancer surgery.…”

“…According to several analyses, the long-term survival outcomes for patients with sentinel node macrometastases were not significantly different between those who did not undergo ALND and those who did ( 3 , 9 ). The Z0011 trial in the American College of Surgeons Oncology Group (ACOSOG) used to be the first randomized managed scientific trial to determine whether patients with breast cancer, whose sentinel lymph nodes were positive, could be likely to avoid ALND ( 8 ). The trial showed that patients with T 1–2 tumors who underwent breast-conserving treatment and postoperative radiotherapy could avoid ALND when the number of positive sentinel lymph nodes was one to two ( 10 - 12 ).…”