Reduced in vivo local recurrence with contact neodymium: Yttrium‐aluminium‐garnet (Nd:YAG) laser scalpels

Abstract

Local recurrence after surgical resection for breast cancer is a significant problem and is often not controlled by radiation or chemotherapy treatments. Local recurrence is thought to be, at least in part, due to residual disease, and/or due to the contamination of the surgical field during resection. STUDY DESIGN MATERIALS AND METHODS: To address this later concern, we defined a model system using the mouse mammary cell line, EMT6. Using this model system, we have directly compared the rate of local recurrence of two different surgical approaches. One approach employed the use of traditional surgical instruments, and the other used a comparatively new contact Nd:YAG laser system. Tumor-bearing animals (242) were randomized into three groups. One group consisted of 50 animals that were not treated; 103 animals were randomized into a treatment group that received surgical resection using traditional instruments; 89 animals were resected using the contact laser system. In both surgical procedures, an intentional incision was made through the tumor and then through an uninvolved portion of the surgical field in an attempt to "seed" the incision using the contaminated surgical instrument. Twenty-one of the 103 scalpel-treated animals had local recurrence; only seven of the 89 laser-treated animal had local recurrence. The untreated group died of disease within 8 weeks. In the treatment groups, recurrences were palpable within 1 week. At the time of death for all groups, no metastatic lesions were noted. These findings support the conclusions that the EMT6 cell line is a useful model to study local recurrence and that contact laser surgery provides about a 50% improvement in the control of local disease in vivo (P < 0.05).