Background: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND). Methods： From January 1, 2003 to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection). 996 eligible patients were enrolled. Results： The final cohort of 996 patients was followed for an average of 198 months. The events other than death differed significantly between the two cohorts（p=0.0311） (46.3% in MALND and 53.2% in CALND, respectively). The sum of the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups ( p =.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p = .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year. Conclusions： The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.

Backgroud: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND). Methods： From January 1, 2003 to December 31, 2005,1027 patients with operable breast cancer were randomly assigned to two groups: MALND and CALND. 996 eligible patients were enrolled. The end points are disease free survival and overall survival. Results： The final cohort of 996 patients was followed for an average of 184 months. The distribution of all events was fairly similar between two groups of patients. The incidence of local in-breast events did not differ in a significant manner between two cohorts. Similarly, the rate of distant metastases was not significantly different with 30.0% in MLND and 32.6% in CALND. And no significant difference was observed in other primary tumor between two groups ( p =0.46). Patients who remain alive with no event comprise a total of 37.2% in MALND and 35.4% in CALND. Other primary cancers and deaths from other causes were distributed equally between two groups. The 15-year disease-free survival rates were41.1 percent for the MALND group and 39.6 percent for the CALND group ( p =0.79). MALND was found to be not inferior for overall survival (P =0.54). The 15-year overall survival rates were 49.5 percentafter MALND and 51.2 percentafter CALND ( p =0.86). Probability of overall survival was not significantly different between two groups. Conclusions： MALND does not increase unfavorable events, and also does not affect the long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery.

Objective To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND). Patients and Methods From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival. Results The mean operative blood loss in the MALND group was less than in the CALND group (P<.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (P<.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (P=.001 at 6 months and P=.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (P=.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (P=.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (P=.95). Conclusion Compared with CALND, MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics.