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World Journal of Surgery

, Volume 30, Issue 6, pp 957–964 | Cite as

Endoscopy-assisted Breast-Conserving Surgery for Early Breast Cancer

  • Eun-Kyu Lee
  • Shin-Ho Kook
  • Yong-Lai Park
  • Won-Gil BaeEmail author
Original Scientific Reports

Abstract

Purpose

Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome, endoscopic breast-conserving surgery, which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken.

Methods and materials

From October 2002 to October 2004, 20 breast cancer patients whose tumor sizes were less than 3 cm and who were clinically node negative without invasion to the skin and pectoralis major muscle underwent endoscopic breast-conserving surgery. First, endoscopic dye-guided sentinel node biopsy was done through a low transverse axillary incision lateral to the pectoralis major muscle. The subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. We made the periareolar semicircular incision to create the skin flap and to resect the tumor-containing quadrant by using Visiport and PowerStar scissors. Frozen-section biopsies were done to rule out tumor invasion to the resection margin. Patient characteristics, tumor characteristics, operation time, and amount of bleedings were all evaluated.

Results

The mean age of patients was 45 (range: 25–64). The mean tumor size was 2.2 cm (range: 0.2–4.0 cm). The average operation time of the early 9 cases, except the 3 cases that underwent axillary-node dissection, was 178 minutes, and that of the later 8 cases was 130 minutes (P < 0.001). The mean amount of operative bleeding was 184 ± 130 ml. There were no major complications.

Conclusion

Endoscopic breast-conserving surgery is a new technique that can minimize the long operation scar of classic breast-conserving surgery. In properly selected cases, our results showed the maximized cosmetic satisfaction of the breast cancer patients and a shortened operation time after the learning period, promising it could be an alternative to the classic breast-conserving surgery.

Keywords

Sentinel Node Sentinel Node Biopsy Axillary Node Dissection Early Breast Cancer Endoscopic Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video contribution

Video contribution

References

  1. 1.
    Jemal A, Murray T, Samuel A, et al. Cancer statistics, 2003. CA Cancer J Clin 2003;53:5–26PubMedCrossRefGoogle Scholar
  2. 2.
    Ministry of Health and Welfare, Republic of Korea. Annual report of central cancer registry in Korea (2002.1–2002.12), 2003Google Scholar
  3. 3.
    Fischer B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus radiation for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233–1241CrossRefGoogle Scholar
  4. 4.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–1232PubMedCrossRefGoogle Scholar
  5. 5.
    Arriagada R, Le MG, Rochard F, et al. Conservative treatment versus mastectomy in early breast cancer patterns of failure with 15 years of follow-up data: Institute Gustave–Roussy Breast Cancer Group. J Clin Oncol 1996;14:1558–1564PubMedGoogle Scholar
  6. 6.
    Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation; a very challenging therapeutic approach. Plast Reconstr Surg 1992;90(6):1125–1126PubMedGoogle Scholar
  7. 7.
    Kitamura K, Hashizume M, Sugimachi K, et al. Early experience of endoscopic extirpation of benign tumors via an extramammary incision. Am J Surg 1998;176:235–238PubMedCrossRefGoogle Scholar
  8. 8.
    Tamaki Y, Nakano Y, Sekimoto M, et al. Transaxillary endoscopic partial mastectomy for comparatively early-stage breast cancer. An early experience. Surg Laparosc Endosc 1998;8:308–312PubMedCrossRefGoogle Scholar
  9. 9.
    Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing of total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. New Eng J Med 1989;320:822–828PubMedCrossRefGoogle Scholar
  10. 10.
    Fisher B, Redmond C, Fisher ER, et al. Ten year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without irradiation. New Eng J Med 1985;312:674–681PubMedCrossRefGoogle Scholar
  11. 11.
    NIH Consensus conference. Treatment of early-stage breast cancer. JAMA 1991;265:391–395CrossRefGoogle Scholar
  12. 12.
    Lee EK, Park YL, Pae WK. Endoscopic sentinel node biopsy Korean. J Korean Breast Cancer Soc 2003;6:174–179Google Scholar
  13. 13.
    Penzer RD, Patterson MP, Lipsett JA. Factors affecting cosmetic outcome in breast-conserving cancer treatment—objective quantitative assessment. Breast Cancer Res Treat 1992;20:85–92Google Scholar
  14. 14.
    Shrotria S. Single axillary incision for quadrantectomy, axillary clearance and immediate reconstruction with latissimus dorsi. Br J Plast Surg 2001;54:128–131PubMedCrossRefGoogle Scholar
  15. 15.
    Veronesi U, Salvador B, Luini A, et al. Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with Quadrantectomy, Axillary dissection and Radiotherapy. Ann Surg 1990;211(3):250–259PubMedGoogle Scholar
  16. 16.
    Tamaki Y, Sakita I, Miyoshi Y, et al. Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech 2001;11(6):356–362PubMedCrossRefGoogle Scholar
  17. 17.
    Kitamura K, Hashizume M, Kataoka A, et al. Transaxillary approach for the endoscopic extirpation of benign breast tumors. Surg Laparosc Endosc 1998;8:277–279PubMedCrossRefGoogle Scholar
  18. 18.
    Fukuma E. Endoscopic total mastectomy Japanese. Operation 1999;53(2):153–159Google Scholar
  19. 19.
    Owaki T, Yosinaka H, Ehi K, et al. Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision. Breast 2005;14:57–60PubMedCrossRefGoogle Scholar
  20. 20.
    Ryoo MC, Kagan AR, Wollin M, et al. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma. Radiology 1989;172:555–559PubMedGoogle Scholar
  21. 21.
    Schmidt-Ullrich R, Wazer DE, Tercilla O, et al. Tumor margin assessment as a guide to optimal conservation surgery and irradiation in early stage breast carcinoma. Int J Radiat Oncol Biol Phys 1989;17(4):733–738PubMedGoogle Scholar
  22. 22.
    Laronga C, Kemp B, Johnson D, et al. The incidence of occult nipple-areola complex involvement in breast cancer patients receiving a skin-sparing mastectomy. Ann Surg Oncol 1999;6(6):609–613PubMedCrossRefGoogle Scholar
  23. 23.
    Langer I. Long term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients. Breast Cancer Res Treat 2005;90:85–91PubMedCrossRefGoogle Scholar
  24. 24.
    Waddell BE, Stomper PC, DeFazio JL, et al. Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast. Ann Surg Oncol 2000;7:665–668PubMedCrossRefGoogle Scholar
  25. 25.
    Lagios MD, Margolin FR, Westdahl PR, et al. Mammographically detected ductal carcinoma in situ; frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989;63(4):618–624PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Eun-Kyu Lee
    • 1
  • Shin-Ho Kook
    • 2
  • Yong-Lai Park
    • 1
  • Won-Gil Bae
    • 1
    Email author
  1. 1.Department of Surgery, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Department of Radiology, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulKorea

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