Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy

Sakamoto, Naomi; Fukuma, Eisuke; Teraoka, Ko; Hoshi, Kazuei

doi:10.1007/s12282-015-0600-4

Cited by 18 publications

(24 citation statements)

References 29 publications

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“…Endoscopic breast surgery is a novel surgical method that uses a small incision wound to perform a complete resection of breast tissue. Many studies have shown that the oncological safety of endoscopic mastectomy is adequate relative to traditional operation methods [ 5 , 7 – 9 ]. In our previous study from the Taiwan Endoscopic Breast Surgery Cooperative Group database, the recurrence rate was about 1% for patients who had received a unilateral total mastectomy, supporting the safety of endoscopic surgery for breast cancer [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

et al. 2017

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IntroductionLaparoscopic techniques are commonly used in abdominal and gynecologic surgery, while breast cancer surgery has remained largely unchanged. In Asia, especially in Japan, many surgeons have started to use endoscopic surgery for breast cancer. In Taiwan, endoscopy-assisted breast surgery started in 2010. The benefits of this surgical method include smaller incisions, an axillary anatomic approach, clear vision, no oncologic compromise, and good cosmetic outcomes. This is the first report to discuss the learning curve of endoscopy-assisted breast surgery, including the difficulties experienced.Materials and methodsFrom June 2011 to December 2013, data were collected from 134 patients who received an endoscopic total mastectomy at the Taipei Medical University Hospital (TMUH) or Changhua Christian Hospital (CCH). We divided these patients into a learning group (TMUH, n = 15; CCH, n = 15) and a mature group (TMUH, n = 50; CCH, n = 54). Patient data and perioperative variables were recorded by retrospective chart review. Variables were compared using the χ2 test and Student’s t-test.ResultsThere was a significant difference in operation time (275.3 vs. 228.9 minutes, p < 0.01) between the learning and mature groups. Perioperative variables (lymph node dissection method, nipple preservation, and reconstruction method) were also analyzed, but there were no demographic differences between the groups. The complication rate was higher in the learning group, although this difference was also not statistically significant.ConclusionOur study is the first to discuss the learning curve of endoscopic total mastectomy. The operation time decreased significantly after 15 cases at each hospital. Although the operation is still more time-consuming than traditional methods, it has the benefit of smaller wounds and improved cosmetic outcomes if combined with immediate reconstruction.

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Section: Discussionmentioning

confidence: 99%

The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

et al. 2017

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“…The use of an endoscopic technique in performing NSMs for cancer patients has also been described by Sakamoto et al (59,60) from Japan who uses a combination of an axillary and periareolar incision to perform the dissection off of the pectoralis fascia and the anterior skin flaps, respectively. The axillary incision is first used for the SLN biopsy.…”

Section: Discussionmentioning

confidence: 97%

Nipple sparing mastectomy techniques: a literature review and an inframammary technique

Ashikari¹,

Kelemen²,

Tastan³

et al. 2018

Gland Surg.

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Nipple sparing mastectomy (NSM) has quickly become an accepted technique for patients with selected cancers and for risk reducing surgery. Much of its surgical acceptance over the last decade has been based on the low risk of nipple areolar complex (NAC) occurrence in breast cancer patients. Improved patient satisfaction due to improved cosmetic outcomes with reconstruction have also driven its popularity. We reviewed current English journals to determine the NSM techniques which achieve the lowest complications, best outcomes, and best patient satisfaction. We researched studies showing reductions in complications with improved surgical techniques and patient selection which have been implicated in improved results. In the studies reviewed, incision placement, away from the nipple, resulted in the lowest rates of ischemic nipple complications and the best cosmetic outcomes. The effect of other factors such as surgeon experience and thickness of skin flap development were more difficult to prove. Leaving a 2-3 mm rim of tissue around the nipple bundle was shown to help preserve the nipple vascularity. Lower complication rates with improved outcomes and patient satisfaction were reported in the literature in patients with B or smaller cup sizes, non-smokers, and patients with lower body mass index (BMI). Incision placement, away from the nipple, with preservation of a 2-3 mm rim of tissue around the nipple bundle along with careful patient selection were the most significant variables reviewed which helped to lower complications rates of NSM. Coordinated surgical planning with the breast and plastic surgeons to determine the best surgical approach for each individual patient is necessary to obtain the best results. Although short-term oncologic follow-up seems to be acceptable, longer follow-up will still be needed to define the best breast cancer surgical candidates for the nipple sparing approach.

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“…In total, 22 studies [31][32][33][34][35][36][37][38]42,[47][48][49]54,55,57,[59][60][61]64,[66][67][68] reported local recurrence after immediate implant-based post-mastectomy breast reconstruction (I-IBR) (Fig. 3A, I 2 = 42.1% [95% CI, 3.8%-65.1%]).…”

Section: Immediate Versus Delayed Implant-based Pmbrmentioning

confidence: 99%

“…The weighted average proportion of local recurrences was 0.03 (95% CI, 0.02-0.04). Proportions of regional recurrences after I-IBR were reported in 10 studies 31,[33][34][35]38,48,55,57,60,66 (I 2 = 61.2% [95% CI, 22.6%-80.5%]), including 79 regional recurrences in 2446 patients (3.2%) (Fig. 3B; Table S3b).…”

Section: Immediate Versus Delayed Implant-based Pmbrmentioning

confidence: 99%

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Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction—A systematic review and meta‐analysis

Bargon

Young‐Afat

Ikinci

et al. 2022

Cancer

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BACKGROUND: Oncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current clinical and shared decision-making complex. This is the first systematic review and meta-analysis to evaluate differences in oncological outcomes after immediate versus delayed postmastectomy breast reconstruction (PMBR) for autologous and implant-based PMBR separately. METHODS: A systematic literature search was performed in MEDLINE, Cochrane Library, and Embase. The Cochrane Collaboration Handbook and Meta-analysis Of Observational Studies in Epidemiology checklist were followed for data abstraction. Variability in point estimates attributable to heterogeneity was assessed using I 2 -statistic. (Loco)regional breast cancer recurrence rates, distant metastasis rates, and overall breast cancer recurrence rates were pooled in generalized linear mixed models using random effects. RESULTS: Fifty-five studies, evaluating 14,217 patients, were included. When comparing immediate versus delayed autologous PMBR, weighted average proportions were: 0.03 (95% confidence interval [CI], 0.02-0.03) versus 0.02 (95% CI, 0.01-0.04), respectively, for local recurrences, 0.02 (95% CI, 0.01-0.03) versus 0.02 (95% CI, 0.01-0.03) for regional recurrences, and 0.04 (95% CI, 0.03-0.06) versus 0.01 (95% CI, 0.00-0.03) for locoregional recurrences. No statistically significant differences in weighted average proportions for local, regional and locoregional recurrence rates were observed between immediate and delayed autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrences after autologous PMBR, and of all outcome measures after implant-based PMBR. CONCLUSIONS: Delayed autologous PMBR leads to similar (loco)regional breast cancer recurrence rates compared to immediate autologous PMBR. This study highlights the paucity of strong evidence on breast cancer recurrence after specific types and timings of PMBR.

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Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy

Abstract: E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy.

Cited by 18 publications

References 29 publications

The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study

Nipple sparing mastectomy techniques: a literature review and an inframammary technique

Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction—A systematic review and meta‐analysis

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