Breast Cancer Patients treated by Video-assisted Breast Surgery (VABS) have Better Long-Term Results.

摘要

Introduction & Objectives: The breast conserving surgery and the sentinel node (SN) biopsy became tobe recognized as the standard treatment for early breast cancers. We have reported about cosmetic effectivenessand lower infestation of the video-assisted breast surgery (VABS) for the breast diseases. We devised the transaxillaryretro-mammary (TRAM) approach of VABS. It needs only one skin incision in the axilla and can treatany tumor even in the medial or lower side of the breast without making any injuries on the breast skin. And itcan preserve skin touch sensation. We evaluated the aesthetic results and the curability of this surgical method.Methods: We have performed VABS on 300 patients since December, 2001. The newly devised transaxillaryretromammary-route approach (TARM) was performed on 120 patients of early breast cancer, stage Iand II. After endoscopic sentinel node biopsy, we elongated the axillary skin incision to 2.5 cm. We marked thesurgical margin 2 cm apart from the tumor edge by injecting blue dye into subcutane and retromamma. Wedissected major pectoral muscle fascia to detach retromammary tissue under the tumor. The working space wasmade by lifting traction sutures through the gland. We cut the proximal side of the gland vertically at dyemarking points, and dissect skin flap over the tumor by tunnel method. Then we cut each sides of the glandvertically and removed it through the axillary port by using the tumor collection bag. The breast reconstructionwas done by filling absorbable fiber cotton. The postoperative aesthetic results were evaluated by our originalscore system, ABNSW.Results: Breast conserving surgery was performed on 286 patients (26 after preoperative chemotherapy)and skin-sparing total mastectomy on 14. We do not use the special disposable apparatus. The operative cost isvery low as the conventional one. There was no significant difference in operational infestation. There was noserious complication after surgery. Surgical margin was minimally positive in 2 patients. The original shapes ofthe breast were preserved well. All patients expressed great satisfaction. The follow-up time is 112 months atmaximum and 72 months on average. There is two locoregional recurrence and 12 distant metastases (brain: 4with 2 cancer deaths, lung: 3, liver: 3, bone: 5). 5-year survival rate is 96.5%. With regard to TARM, The skinincision was made only in the axilla without any wound on the breast. It could be applied for any tumors existingin the medial or caudal side of the breast (A and B regions). The reconstruction by filling absorbable fiber cottonneeds no excessive detachment of the skin beyond the surgical margin of the mammary gland. The postoperativeaesthetic results were excellent and good. The sensory disturbance was minimal, observed only in the detachedarea within the surgical margin.Conclusions: VABS can be considered as a surgical procedure with good locoregional control and canprovide aesthetic advantages for patients with breast disease.