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

Background: Longer follow-up was necessary to testify 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. The 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 the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups ( p =.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p = .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year. 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.