Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results

Lai, Hung-Wen; Chen, Shou‐Tung; Mok, Chi Wei; Lin, Ying-Jen; Wu, Hwa-Koon; Lin, Shih-Lung; Chen, Dar‐Ren; Kuo, Shou‐Jen

doi:10.1016/j.bjps.2020.02.021

Cited by 49 publications

(71 citation statements)

References 30 publications

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“…Hospital stays were higher in the Lai et al study (29) for all patients and the two groups in comparison with our practice: 6 days versus 2 days in our study. This might be correlated with the Enhanced Recovery after Surgery program, set up in our institute in 2017, initially for gynecologic, digestive, and urologic surgery.…”

Section: Discussioncontrasting

confidence: 67%

“…Complication rates were not significantly different between two groups (29) as we observed. Complication rates were 41% and 46.8% in the Lai et al study (29), 21.8% and 27.5% in our study, for RNSM and C-NSM groups, respectively. The rate of reoperation was 4.3% in the Toesca et al study among 73 women who underwent 94 R-NSM (10), lesser than our results of 9.2% in each groups.…”

Section: Discussionsupporting

confidence: 47%

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Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

et al. 2021

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BackgroundSeveral studies reported the feasibility and safety of robotic-NSM (R-NSM). The aim of our prospective study was to compare R-NSM and conventional-NSM (C-NSM).MethodsWe analyzed patients who were operated on with and without robotic assistance (R-NSM or C-NSM) and who received immediate breast reconstruction (IBR) with implant or latissimus dorsi-flap (LDF). The main objective was complication rate and secondary aims were post-operative length of hospitalization (POLH), duration of surgery, and cost.ResultsWe analyzed 87 R-NSM and 142 C-NSM with implant-IBR in 50 and 135 patients, with LDF-IBR in 37 and 7 patients, respectively. Higher durations of surgery and costs were observed for R-NSM, without a difference in POLH and interval time to adjuvant therapy between R-NSM and C-NSM. In the multivariate analysis, R-NSM was not associated with a higher breast complication rate (OR=0.608) and significant factors were breast cup-size, LDF combined with implant-IBR, tobacco and inversed-T incision. Grade 2-3 breast complications rate were 13% for R-NSM and 17.3% for C-NSM, significantly higher for LDF combined with implant-IBR, areolar/radial incisions and BMI>=30. A predictive score was calculated (AUC=0.754). In logistic regression, patient’s satisfaction between C-NSM and R-NSM were not significantly different, with unfavorable results for BMI >=25 (OR=2.139), NSM for recurrence (OR=5.371) and primary breast cancer with radiotherapy (OR=4.533). A predictive score was calculated. In conclusion, our study confirms the comparable clinical outcome between C- NSM and R-NSM, in the price of longer surgery and higher cost for R-NSM. Predictive scores of breast complications and satisfaction were significantly associated with factors known in the pre-operative period.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionsupporting

confidence: 47%

Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

et al. 2021

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“…Patients-reported aesthetic results following breast reconstruction were assessed using a selfadministered questionnaire, which had been used in our previous studies [29][30][31][32]. The self-administered questionnaire, which was designed to evaluate the aesthetic result of breast cancer patients received breast reconstruction, was conducted at 3 months after the operation when their surgical wounds had healed.…”

Section: Clinical Outcome and Patients-reported Aesthetics Resultsmentioning

confidence: 99%

“…More studies and reports from other ORBS were needed to consolidate this concept. The questionnaire, which had been used and published in our previous studies [29][30][31][32], we used at current report was different from the common used questionnaire like "BREAST-Q" [14], and might not be so comprehensive and well adopted. Based on our experiences, a surgeon to be trained as an ORBS should be a certi ed breast surgeon, who is familiar with conventional breast cancer operations and treatment.…”

Section: Discussionmentioning

confidence: 99%

Oncoplastic Reconstructive Breast Surgeon (ORBS) Performance and Impact on Breast Reconstructions: Clinical Outcome, Learning Curve, and Patient Reported Aesthetic Results- An analysis of 451 Procedures

Lai¹,

Lin²,

Chen³

et al. 2020

Preprint

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Oncoplastic and reconstructive breast surgeon (ORBS) aimed to incorporate aesthetics and plastic technique into breast cancer operations to balance the oncologic safety and cosmetic outcome, and also to promote breast reconstructions. The outcome of breast reconstruction performed by an ORBS was reported from a single institute. Among the 451 breast reconstructions performed by an ORBS, 75.8% were gel implant reconstructions, 3.3% were tissue expander, 16.9% were transverse rectus abdominal myocutaneous (TRAM) flap, 3.1% latissimus dorsi (LD) flap, and 0.9% LD flap + implant. The patients reported aesthetic evaluation showed that 53.9% responded excellent, 41.1% good, 4.4% fair, and 0.6% poor. In cumulative sum plot learning curve analysis, it took around 58 procedures for an ORBS to be familial with mastectomy followed by immediate gel implant reconstruction and to significantly decrease the operation time. In multivariate analysis, younger age, MRI, nipple sparing mastectomy, ORBS, and high-volume surgeon were factors related to breast reconstructions. Current study demonstrated that a breast surgeon after adequate training could become an ORBS and perform breast reconstructions with adequacy. Complimentary to traditional breast surgeon-to-plastic surgeon breast reconstruction pathways, ORBS could increase breast reconstructions rate, which remained low worldwide.

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“…It was found that for early breast cancer and benign conditions, RANSM along with IBR is surgically safe and feasible. According to a study, RANSM followed by IBR has relatively better results and considerably better patient satisfaction compared to the Conventional Nipple-sparing Mastectomy (CNSM) followed by IBR [81]. The only drawback is being longer operation time and higher cost.…”

Section: Breast Cancermentioning

confidence: 99%

Robots in Cancer Surgery: A Boon or Bane

Jamal¹,

Alshahrani²,

Arif³

et al. 2020

JCT

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Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results

Cited by 49 publications

References 30 publications

Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

Oncoplastic Reconstructive Breast Surgeon (ORBS) Performance and Impact on Breast Reconstructions: Clinical Outcome, Learning Curve, and Patient Reported Aesthetic Results- An analysis of 451 Procedures

Robots in Cancer Surgery: A Boon or Bane

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