乳がんにおける腋窩リンパ節転移に対するロボット支援腋窩リンパ節郭清

Current experience with robotic-assisted axillary lymph node dissection (R-ALND) is limited. Axillary lymph node dissection is essential for patients with pathological N2-3 disease, but conventional open surgery carries a risk of injury to the intercostobrachial nerve, leading to sensory deficits, pain, and reduced quality of life. R-ALND may enhance precision through minimally invasive techniques, potentially reducing complications. Patients with breast cancer who underwent R-ALND at our institution between March 2024 and March 2025 were enrolled and analyzed. The procedure used the da Vinci system, following a systematic "bottom-up, back-to-front" sequence for axillary dissection, with emphasis on preserving the intercostobrachial nerve and blood vessels. The clinical characteristics, surgical outcomes, complications, and recurrence of R-ALND were analyzed. The mean operative time was 48.16 ± 9.65 minutes, with a median blood loss of 3.00 (2.00, 5.00) mL. A median of 18.00 (13.00, 22.00) lymph nodes were dissected, of which a median of 1.00 (1.00, 4.00) was metastatic. During a mean follow-up period of 8.70 ± 3.24 months, no cases of hemorrhage, infection, seroma, lymphorrhagia, upper limb lymphedema, or recurrence occurred. R-ALND is a safe and precise technique for axillary lymph node dissection, significantly reducing perioperative complications. Its technical advantages include 3-dimensional visualization and enhanced instrument maneuverability, although further validation of long-term survival benefits is required.