Comparison Of Mastoscopic And Conventional Axillary Lymph Node Dissection In Breast Cancer: A Meta-analysis

Objective: To review the efficacies of endoscopic assisted axillary lymph nodedissection and conventional open axillary lymph node dissection in patients with breastcancer in order to provide evidence for doctors and patients in selecting operation methods.Methods: Randomized controlled trials（RCTs）on endoscopic assisted axillary lymphnode dissection and conventional open axillary lymph node dissection in the treatment ofbreast cancer were searched from PubMed，EMBase，VIP，CBM，CNKI，Wanfang Dataand the relevant published data，conference papers and their references either in English orChinese were also searched manually.The searching words were breast tumor，breastcancer，axillary lymph node dissection，randomized controlled trial，axillary lymph nodedissection，axillary dissection，endoscope and cavity mirrors.The data were extracted andthe methodological quality of the involved researches was evaluated by two reviewersindependently，and RevMan5.0software was used for Meta analysis. Results: A total of8RCTs were involved，including1424patients.Meta analysis showed that compared withconventional open axillary lymph node dissection，endoscopic assisted axillary lymphnode dissection operation could reduce the amount of intra-operative bleeding [WMD=34.22，95%CI（36.52，31.92），P <0.00001]，and reduce the armpit lymph drainagevolume [WMD=78.87，95%CI (85.78，71.95)，P<0.00001]，and also reduce thepost-operative complications [O R=0.29，95%CI（0.12，0.69），P=0.05]，but prolongthe operation time [WMD=29.68，95%CI (27.11，32.24），P <0.00001]，but showed nostatistically significant differences in the intra-operative cleaned lymph node number[WMD=-0.39，95%CI(-0.85，0.07)，P=0.09]，axillary drainage time [WMD=-0.17，95%CI (0.37，0.04)，P=0.11]，post-operative hospitalization time[WMD=-0.23，95%C I (-0.79，0.33)，P=0.41] and post-operative recurrence [OR=2.39，95%CI(0.58，9.84)，P=0.23]. Conclusion：Endoscopic-assisted axillary lymph node dissection shouldbe promoted owing to its advantages of minimal invasion，low complication rate，rapid recovery and invisible scar. However，the surgical technique remains to be furtherimproved to reduce the prolonged operating time.Because of the low quality of theinvolved researches，the above conclusion still need to be validated by carrying out morerandomized controlled trials with multiple centers and bigger sample and enough followup time.