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Thoracoscopic internal mammary lymph nodes dissection: a staging tool for internal mammary lymph nodes in breast cancer

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The Chinese-German Journal of Clinical Oncology 2011年第10期10卷 580-583页

作者： Waheed Yousry Garee Hesham Elsebaie Haytham Gareer Hytham Ahmed Mohamed Wafa Hussein Soliman Surgical Oncology National Cancer InstituteCairo UniversityCairoEgypt Surgical Oncology Tanta University HospitalTantaEgypt

Objective： The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer. Methods： During the period from June 2004 to May 2007, 50 patients with operable breast cancer underwent modified radical mastectomy （MRM） or breast conserving surgery （BCS）, followed by thoracoscopic internal mammary lymphadenectomy, using 3 ports through the skin incision of the MRM or the BCS. Metal clips were used to mark precise site of lymphadenectomy. Results： of total number of 50 patients, the mean age of patients was 44 years （range, 27-60 years）. 40 （80%） had medio-central tumor, 10 （20%） had lateral tumor. 35 （70%） had clinically involved axillary nodes. 16 out of 50 patients received neo-adjuvant CTH. 44 patients underwent MRM and 6 patients underwent BCS. No intra-operative complications occurred. Atelectasis was the only postoperative complication that was encountered, which occurred in 12 cases, and was treated conservatively. The average chest drainage period was 1.2 day （range, 1-2 days）. The total number of IMN metastasis was 18 patients （36%）. The risk of IMN metastasis was higher; in younger patients （P = 0.03）, in medio-central tumors （P = 0.03）, in bigger tumors （P = 0.05）, with heavier metastasis of axillary LNs （P = 0.001）. But a correlation with the histological pattern of the lry tumor didn＇t exist （P = 1）. Knowing the IMN status helped in proper staging of patients, 7 patients showed evident stage migration after adding the IMN analysis to that of primary tumor and axillary LN. During the follow up period （the median, 22 months; range, 7 to 42 months）, no patient had pleural dissemination or port-site metastasis. Conclusion： Thoracoscopic IMN lymphadenectomy is a safe procedure, which can be done serious additional complications or cosmetic compromise. And allow proper nodal staging, which allow proper treatment planning.

关键词： breast cancer internal mammary lymph nodes lymphadenectomy thoracoscopic staging

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