Robotic axillary lymph node dissection improves outcomes in breast cancer: Study

Robotic axillary lymph node dissection is associated with quick postoperative recovery and positive aesthetic effects in breast cancer patients, reveals a new study published in The International Journal of Medical Robotics and Computer Assisted Surgery.

Breast cancer (BC) is one of the most common malignant tumours, at present, surgery is one of the main approaches for BC treatment. One of the fuming topics in present day breast surgery is the management of axilla, where a majority are opting for Axillary lymph node dissection (ALND) from the existing options.

ALND is a controversial approach but it remains a significant surgical intervention in patients to execute against axillary lymph node metastasis during BC. However, ALND is associated with complications like lymphedema, wound infection, fat necrosis, arm paraesthesia and range-of-motion restriction. Hence, endoscopic surgery is a recent approach that is revolutionizing minimally invasive breast surgery. As such, robot-assisted surgery seems to be the next evolutionary step in patient safety, high efficacy and precision surgery.

Study design:

This study was done by surgeons from Zhengzhou University China and Sechenov University Russia. The current study delineated the significance of da Vinci robot-assisted ALND (dVALND) rather than conventional ALND in BC patients.

They selected a total of 60 female patients with BC who underwent ALND between 34 and 63 years old, with an average age of 47.41 ± 8.6 years. Later, the patients were segregated into two groups (Group 1 and Group 2) of 30 patients each. Modified radical mastectomy for BC was performed to the patients in both groups.

In Group 1 (control group), ALND was performed using conventional mode of axillary lymph node surgery. In Group 2 (Test group), the ALND was performed using da Vinci robot-assisted surgery. The total surgical operation time, time taken for lymph node dissection and the amount of intraoperative blood loss were recorded. Postoperative follow-up was performed to record the incidence of complications and patient satisfaction. The results obtained in both groups are compared to delineate the efficacy of dVALND. The axillary lymph nodes were divided into three levels with the pectoralis minor muscle as the boundary mark. Primarily, level I and II nodes were dissected. Robot-assisted axillary dissection was performed through the main incision.

Efficacy of surgical procedure

Without further elongation of primary incision ALND was performed using da Vinci robot-assisted technology. On average, the blood loss was 10.31 ± 3.6 ml. The total surgical time was on average 50.42 ± 11.12 minutes. Of those, the duration of modified radical mastectomy of the right breast with retention of nipple-areolar complex was on average 20 minutes, whereas the dVALND lasted for ∼20 minutes, and secondary robotics manipulations lasted up to 10 minutes on average.

Complications

There were very minimal postoperative complications and other wound infection, fat necrosis and lymphedema of the upper limbs. Thus, overall incidence of complications in Group 2 significantly mitigated with da Vinci robotic surgical intervention than the conventional type of ALND.

Aesthetic effect and patient satisfaction

The patient recovery rate was extensively well after da Vinci robotics surgery. "The incision was not obvious, without any significant hematoma or other complications. The aesthetic effect was satisfactory. During a 3-month follow-up, the degree of patient's satisfaction was noted as 'highly satisfied'."

Advantages in robotic surgery group:

In the present surgical study, the efficacy of dVALND in 30 BC patients is supported by the conclusions of minimized post-operative complications compared to conventional ALND. a 3-cm incision was adopted in this surgery. "Furthermore, the high-definition, three-dimensional imaging system of da Vinci robotic surgical system could precisely identify blood vessels and lymph nodes effectively. Thus, the da Vinci robotic system is accompanied by the clearer surgical view and we avoided any damage to blood vessels and nerves. Since it can be used to execute whole surgical intervention with a small surgical incision, the patient recovered quickly after surgery with low incidence of severe complications such as wound infection, fat necrosis and lymphedema of upper limbs."

Conclusion:

The authors concluded that "Though the expenses for the usage and cost of ownership of the da Vinci robot-assisted surgical system are relatively high, yet it has significant advantages over other techniques due to its ability in fostering a clear three-dimensional surgical view, simple and flexible surgical manoeuvres, less traumatization and low complication rate. Therefore, the patient's postoperative recovery is quick, with positive aesthetic effects and high satisfaction degree."

Source: Kuo Chen et al. "Efficacy of da Vinci robot-assisted lymph node surgery than conventional axillary lymph node dissection in breast cancer – A comparative study." https://doi.org/10.1002/rcs.2307