Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection...

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Management

Background:

• Lymphedema is a risk following breast cancer treatment involving axillary lymph node dissection (ALND) and radiation.
• Immediate lymphatic reconstruction (ILR) aims to mitigate lymphedema post-ALND.
• Sentinel lymph node biopsy (SLNB) or targeted axillary excision may precede ALND, which can be performed immediately or after permanent pathology review.

Purpose of the Study:

• To evaluate the impact of immediate ALND/ILR following positive intraoperative frozen sections.
• To guide surgical decision-making and operative planning in breast cancer patients.

Main Methods:

• Retrospective review of 148 breast cancer patients undergoing mastectomy, tissue expander reconstruction, and axillary node surgery (2019-2022).
• Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion (Group 2).
• Demographic data and operative times were recorded and compared between groups.

Main Results:

• Group 1 (immediate ALND/ILR) included 30 patients; Group 2 (no immediate ALND) included 118 patients.
• Immediate conversion to ALND/ILR significantly increased operative time by approximately 80 minutes for both unilateral and bilateral procedures compared to no immediate ALND.
• Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 vs. 222.6 ± 52.2 minutes in Group 2 (p=0.001).

Conclusions:

• Intraoperative frozen section analysis leading to immediate ALND/ILR extends operative time by about 80 minutes.
• This approach introduces unpredictability and additional operative time but avoids a second surgical procedure for staging.
• The findings aid in surgical planning and decision-making regarding immediate versus delayed ALND.