A pilot study on thoracoscopic internal mammary lymphatic chain dissection for breast cancer

To evaluate the feasibility of internal mammary lymphatic chain dissection by thoracoscopic surgery.

Thirty-two breast cancer women were involved in this pilot study, who were with lesion located at central area or internal quadrant, or with cN2 or cN3 ALNs, or with T4 tumor, or indicating IMNs drainage by preoperative lymphoscintigraphy, but without distant metastasis. Subareolar injection and peritumoral injection of 5 ml methylene blue were done before operation. Double cavity intubation was used to permit collapse of the homolateral lung and set-up the endoscopic operation space. Trocars were introduced through three thoracic incisions of less than 15 mm at the third, the fifth and the seventh intercostal spaces along the midaxillary line. Dissection of internal mammary lymphatic chain was performed by a thoracoscopic grasper and ultrasonically activated scalpel.

Thoracoscopic internal mammary lymphatic chain dissection was successfully finished in 28 patients. The procedure time was 30-70 min (45.2+/-9.6 min). A total of 128 internal mammary nodes were removed. Among the 28 patients, 11 had internal mammary node metastasis. Only one patient had internal mammary node metastasis without axillary node metastasis. All internal mammary nodes were located at the first rib to the fourth intercostal space. Thoracoscopic internal mammary lymphatic chain dissection in four patients was impossible because of unfavorable local anatomic conditions. There was no damage on great vessels or the lungs, nor pulmonary atelectasis or pulmonary infection.

Thoracoscopic internal mammary lymphatic chain dissection is feasible, and it is easy to perform without serious additional complications. It may improve nodal staging of breast cancer with internal mammary node.