title: Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients.
abstract: BACKGROUND
  Reports on long-term outcomes after endoscopic axillary lymph node dissection (ALND) of breast cancer patients are still lacking in the medical literature. The objective of this prospective study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND.
  
  
  METHODS
  Fifty-five breast cancer patients were prospectively enrolled, of whom 52 were available for follow-up with a median of 71.9 months (range 11-96). The following oncological and functional endpoints were evaluated during follow-up at several time points: occurrence of local, axillary and distant metastases, seroma or infection, shoulder mobility (range of motion), numbness, pain, presence of lymphoedema as well as restriction in activities of daily living.
  
  
  RESULTS
  In 52 patients endoscopic ALND of level I and II was successfully performed. Two port-site metastases (2/52, 4%) occurred, one of which in a patient with negative axillary lymph nodes. The same patient suffered from the only axillary recurrence (1/52, 2%). Three patients (3/52, 6%) developed lymphoedema. No other functional adverse events (shoulder mobility, pain, numbness, hypertrophic scar) were noticed at the end of the observation period.
  
  
  CONCLUSIONS
  The present investigation with long-term follow-up after endoscopic ALND--the first one in the literature--reveals minor morbidity, good functional and cosmetic results. In contrary to conventional surgery, the endoscopic procedure is associated with the occurrence of port-site metastases, not seen in the open approach. Axillary recurrences do not appear more frequently when compared with results after conventional ALND. In the meantime the less invasive sentinel lymph node (SLN) biopsy is the established standard technique in evaluating the axillary lymph node status.
authors.affiliation: Department of Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland. ilanger@uhbs.ch
authors.forename: I
authors.initials: I
authors.lastname: Langer
authors.forename: T
authors.initials: T
authors.lastname: Kocher
authors.forename: U
authors.initials: U
authors.lastname: Guller
authors.forename: J
authors.initials: J
authors.lastname: Torhorst
authors.forename: D
authors.initials: D
authors.lastname: Oertli
authors.forename: F
authors.initials: F
authors.lastname: Harder
authors.forename: M
authors.initials: M
authors.lastname: Zuber
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008209:Lymphedema / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome