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

Introduction Longer follow-up was necessary to determine 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. 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 events other than death and deaths from other causes was much higher in the CALND (59.6%) than MALND (53.4%) group ( p = 0.0494). The 17-year disease-free survival DFS rates were 36.7% for the MALND and 33.6% for the CALND group, respectively. There was a significant difference between the groups ( p = 0.0306). Overall survival (OS) rates were 53.2% after MALND and 46.0% after CALND ( p = 0.0119). MALND patients had much less axillary pain ( p = 0.0000), numbness or paresthesia ( p = 0.0000), arm mobility ( p = 0.0000) and arm swelling on the operated side ( p = 0.0000). Aesthetic appearance of the axilla was much better in the MALND than CALND group ( p = 0.0000) at an average follow-up of 17 years. 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. Trial Registration Information The comparison of long-term outcomes of mastoscopic and conventional axillary lymph node dissection in breast cancer: a multicenter randomized control trial. ChiCTR-TRC-11001477, CHiCTR. First registration 08/14/2011.