Minimal Access (Endoscopic and Robotic) Breast Surgery in the Surgical Treatment of Early Breast Cancer—Trend and Clinical Outcome From a Single-Surgeon Experience Over 10 Years

Lai, Hung-Wen; Chen, Shou‐Tung; Lin, Ying-Jen; Lin, Shih-Lung; Lin, Ching‐Yuan; Chen, Dar‐Ren; Kuo, Shou‐Jen

doi:10.3389/fonc.2021.739144

Cited by 29 publications

(37 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, no differences in overall survival (OS) and disease-free survival (DFS) have been reported between minimally invasive and conventional breast surgical (CBS) methods. Endoscopic and robotic breast surgery have been applied in studies on minimal access breast surgery (MABS), robotic nipple-sparing mastectomy, mastoscopic axillary lymph node dissection, endoscopic-assisted nipple-sparing mastectomy, endoscopy-assisted breast conservation surgery, and laparoscopy-assisted breast reconstruction. …”

Section: Introductionmentioning

confidence: 99%

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

et al. 2022

View full text Add to dashboard Cite

ImportanceMinimal access breast surgery (MABS) has been used in breast cancer management. However, long-term prognostic data associated with MABS vs conventional breast surgery (CBS) are lacking.ObjectiveTo investigate long-term therapeutic outcomes associated with MABS vs CBS for breast cancer management.Design, Setting, and ParticipantsIn this single-center retrospective cohort study, 9184 individuals were assessed for inclusion. After exclusions, 2412 adult female individuals were included who were diagnosed with stage 0 to III breast cancer, underwent unilateral breast surgery between January 2004 and December 2017, and had no distant metastasis or history of severe underlying disease. Propensity score matching was performed to minimize selection bias. Data were analyzed from January 1, 2004, to December 31, 2019.ExposuresMABS or CBS.Main Outcomes and MeasuresData on demographic and tumor characteristics and long-term outcomes were collected and analyzed.ResultsThis study included 2412 patients (100% female; median [IQR] age, 44 [40-49] years). Of these, 603 patients underwent MABS (endoscopic, endoscopy-assisted, or robot-assisted procedures in 289, 302, and 12 patients, respectively) and 1809 patients underwent CBS. The median follow-up time was 84 months (93 in the MABS group and 80 months in the CBS group). Intergroup differences were not significant for the following parameters: 10-year local recurrence-free survival (93.3% vs 96.3%; hazard ratio [HR], 1.39; 95% CI, 0.86-2.27; P = .18), regional recurrence-free survival (95.5% vs 96.7%; HR, 1.38; 95% CI, 0.81-2.36; P = .23), and distant metastasis-free survival (81.0% vs 82.0%; HR, 0.95; 95% CI, 0.74-1.23; P = .72). The 5-, 10-, and 15-year disease-free survival rates in the MABS group were 85.9%, 72.6%, and 69.1%, respectively. The corresponding rates in the CBS group were 85.0%, 76.6%, and 70.7%. The intergroup differences were not significant (HR, 1.07; 95% CI, 0.86-1.31; P = .55). The 5-, 10-, and 15-year overall survival rates in the MABS group were 92.0%, 83.7%, and 83.0%, respectively. The corresponding rates in the CBS group were 93.6%, 88.7%, and 81.0%. The intergroup differences were not significant (HR, 1.29; 95% CI, 0.97-1.72; P = .09). Post hoc subgroup analysis showed no significant intergroup differences in disease-free survival.Conclusions and RelevanceIn this cohort study, long-term outcomes following MABS were not significantly different from those following CBS in patients with early-stage breast cancer. MABS may be a safe and feasible alternative in this patient population.

show abstract

Section: Introductionmentioning

confidence: 99%

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

et al. 2022

View full text Add to dashboard Cite

show abstract

“…As shown in supplementary le 1, the single axillary incision, which characterized with small and extra-mammary axilla or lateral chest located scar, spared an incision of the skin ap on the breast, could prevent disruption of vascular supply to the NAC or skin ap, and expected to lower the risk of NAC or skin ap ischemia necrosis (Tables 2 & 3). However, at these incision locations and size of wound, it is very di cult to perform NSM without the assistance of endoscopic or robotic surgical platform (32). In current study, most of the single axillary incision NSMs were performed by either endoscopic or robotic assisted NSM, which were characterized as minimal access NSM (32).…”

Section: Discussionmentioning

confidence: 90%

“…However, at these incision locations and size of wound, it is very di cult to perform NSM without the assistance of endoscopic or robotic surgical platform (32). In current study, most of the single axillary incision NSMs were performed by either endoscopic or robotic assisted NSM, which were characterized as minimal access NSM (32).…”

Section: Discussionmentioning

confidence: 90%

“…Skin incisions were divided into the following categories for analytic purpose: upper outer incision (radial incision), peri-areolar incision (with or without axillary incision), single axillary incision, and infra-mammary +axillary incisions (Supplementary File 1). The NSM procedures performed with single axillary incisions in current study were mainly cases performed with endoscopic assisted or robotic assisted NSMs (32).…”

Section: Type Of Skin Ap Incisionsmentioning

confidence: 99%

See 1 more Smart Citation

Nipple areolar complex (NAC) or skin flap ischemia necrosis post nipple sparing mastectomy (NSM)-Analysis of clinicopathologic and breast magnetic resonance imaging (MRI) factors

Lai

Lee²,

Chen

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background The purpose of this study is to identify clinicopathologic factors and/or pre-operative MRI vascular patterns in the prediction of ischemia necrosis of the nipple-areola complex (NAC) or skin flap post nipple sparing mastectomy (NSM). Methods Patients who received NSM were retrospectively retrieved from a prospectively collected breast cancer database in one institute. The ischemia necrosis of NAC or skin flap was evaluated with clinicopathologic factors and types of skin incision. Patients who received NSM with pre-operative MRI evaluation were further evaluated for the vascular pattern and the impact on ischemia necrosis of NAC or skin flap. Results A total of 441 cases received NSM enrolled in current study, and the mean age of them was 49.1 ± 9.8-year-old. A total of 41(9.3%) NSM procedures were graded as NAC ischemia necrosis. Risk factors associated with NAC necrosis were evaluated, and old age, large mastectomy specimen weight (> 450gm), and peri-areola incision were identified. 270 NSM procedures also received pre-operative MRI, and the blood supply pattern was 18% single vessel type, and 82% double vessel. There was no correlation of MRI blood supply pattern to ischemia necrosis of NAC, nor correlated with NAC ischemia necrosis in either type of skin flap incision. There was no correlation between blood loss and pattern or size of blood vessel. Conclusion Certain factors, like the type of skin incision, age, and size of mastectomy weight, played important role in ischemia necrosis of NAC, however, MRI vascular (single or dual vessel supply) pattern was not a significant predictive factor.

show abstract

“…All our patients in the SIE-BCS group had a single axillary incision, so there was no surgical incision on the breast surface, which is a novel advantage of this technique. From a clinical standpoint, the SIE-BCS technique increased the operation time as compared to conventional surgery [ 24 ]; this phenomenon has been reported extensively, and examples of this can be found in gastrointestinal [ 25 ], hepatobiliary [ 26 ], and thyroid surgeries [ 27 ]. However, our clinical care teams do not begrudge the additional time and effort, in light of the benefits to the postoperative well-being of the patients (personal communications).…”

Section: Discussionmentioning

confidence: 99%

Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer

Xie

Wang²,

Wu³

et al. 2022

World J Surg Onc

View full text Add to dashboard Cite

Background In the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer. Methods A total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale. Results The mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis. Conclusion The novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.

show abstract

Minimal Access (Endoscopic and Robotic) Breast Surgery in the Surgical Treatment of Early Breast Cancer—Trend and Clinical Outcome From a Single-Surgeon Experience Over 10 Years

Cited by 29 publications

References 43 publications

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

Nipple areolar complex (NAC) or skin flap ischemia necrosis post nipple sparing mastectomy (NSM)-Analysis of clinicopathologic and breast magnetic resonance imaging (MRI) factors

Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer

Contact Info

Product

Resources

About