Efficacy and safety of endoscopic versus robotic axillary lymph node dissection in patients with node-positive breast cancer: a comparative retrospective study

Background. Robotic surgery for breast cancer is increasingly being adopted, but the evidence on its effectiveness and safety remains limited. This study aimed to compare the surgical quality and short-term outcomes of robotic and endoscopic axillary lymph node dissection in patients with node-positive breast cancer. Here we report the short-term outcomes of this trial. Methods. This single-center retrospective study compared the short-term efficacy and safety of endoscopic (E-ALND) and robotic (R-ALND) axillary lymph node dissection in patients with node-positive breast cancer. Patients were recruited from those who underwent surgery at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2022 and October 2024. Clinical and pathological characteristics, surgical outcomes, and postoperative complications were analyzed. Results The study included 56 patients, with 29 undergoing E-ALND and 27 undergoing R-ALND. The R-ALND group had significantly shorter surgical times (43.37 ± 12.40 min vs. 60.10 ± 19.37 min, p < 0.001) and lower mean blood loss (3.26 ± 2.40 ml vs. 9.24 ± 4.29 ml, p < 0.001). Postoperatively, the R-ALND group had better upper limb function and sensation, with significantly lower DASH scores at 1-month (10.87 ± 1.35 vs. 14.64 ± 3.49, p < 0.001) and 3-month (6.68 ± 1.86 vs. 9.24 ± 2.74, p < 0.001) follow-ups. The R-ALND group also had fewer postoperative complications, including a lower incidence of reduced sensation, burning sensation, and numbness in the upper limb. Conclusion Compared with E-ALND, R-ALND significantly reduces intraoperative bleeding and postoperative complications, resulting in better upper limb function and sensation. These findings suggest that R-ALND may offer superior clinical outcomes for patients undergoing axillary lymph node dissection for breast cancer.