The dissertation solves an important scientific and practical task, which is to improve tactics to increase the effectiveness of surgical treatment and improve the quality of life of women with early breast cancer by reducing the volume of axillary lymphadenectomy through the use of intraoperative fluorescent ICG-lymphography.
The work is based on studying the results of a comprehensive examination, treatment and dynamic monitoring of 107 patients with early operable forms of infiltrative breast cancer (BC I - IIa). The main group of study were 50 patients with early forms of breast cancer, operated with intraoperative guard lymph node imaging methods using ICG-technology. In the control group (57 women) a mandatory condition was the implementation of the full volume of regional lymph dissection of I - III level.
Comprehensive examination, treatment and dynamic monitoring of 57 patients who underwent radical mastectomy along with full regional lymph node dissection I - III level, showed that in the vast majority of cases (93.0%) such surgery is considered excessive, inappropriate, and disabling , showed a positive correlation with the frequency of postoperative side effects and complications, in particular, secondary lymphedema (r = 0.38; p <0.001), and significantly reduced quality of life.
It is proved that the alternative of regional lymphadenectomy of I-III level for the category of patients with early breast cancer with clinically unaffected lymph nodes is a dissection of sentinel lymph node (SLN) with the use of its intraoperative fluorescence imaging by ICG-technology, which is characterized by simplicity, high sensitivity and specificity, no need for special training of the patient and radiation exposure, which allows to recommend its use in clinical practice for the diagnosis of metastases in both SLN and regional lymph nodes.
It is shown that in the group of patients where intraoperative ICG-technology was applied the frequency of the signal lymph nodes presence was 100%, which confirms the high reliability of the diagnostic features of the method and their conformity with international standards. At the same time the average number of investigated sentinel lymph nodes ranged from 2 to 3, and the nature of surgical intervention did not affect on the number of investigated SLN (2.5 ± 0,2), which meet generally accepted criteria.
Comparative analysis of early postoperative period and terms of patients’ stay in hospital of the main and control clinical group found that in patients, where intraoperative ICG-technology was used, the length of postoperative chylorrhea, its volume, as well as the total amount of bed days were 4.8 times (p < 0.001), 2.7 times (p < 0.001) and a 4.6 times (p < 0.001), respectively statistically significantly lower than in the control group.
It is shown that the development of secondary lymphedema (SL) hands on the side of surgical intervention had a place in the late postoperative period, 2 of 10 patients of the group (20%) and in 16 of 57 patients with the reference group (28.1%), which was carried out of regional limfodysektsiya. At this, timing of early signs of secondary lymphedema detection in the control group, in particular an increase in the circumference of the upper limbs in the standard zone measuring 0.5-2.5 cm in comparison with the intact limb, ranged from 12 to 24 months, peaking statistically significant difference within 3 - 4.5 cm (p <0.05) in 30-36 months after surgical intervention.
It was found that a significant factor determining the development of SL after surgical treatment of early forms of breast cancer was the body mass index (r = 0.45; p <0.001).
It was shown that the parameters of physical, mental and social functioning in women with early breast cancer after axillary lymphadenectomy of I - III level were significantly lower than in patients operated on for early breast cancer with preservation of the axillary lymphatic system, on all scales. Thus, patients suffered from role functioning disorders the most, which reflected a significant limitation of both the volume and type of their daily activities: the RP coefficient of women in the control group was 46.6% statistically significantly lower (p <0.01) than in patients of the main group. The comparative nature of the changes was observed for markers of physical health and vital activity, the level of reduction of which in the control group of patients was 33.1% (p <0.01) and 41.5% (p <0.01), respectively, in comparable with patients of the main clinical group.
To improve results of SLN finding the use of fluorescence ICG-navigation technology and ICG-camera is recommended. Reduction of regional lymph dissection volume in patients with early forms of breast cancer should be recommended for implementation in clinical practice of all hospitals in Ukraine that provides certified specialized cancer care.
