Robotic Versus Conventional Nipple-Sparing Mastectomy With Immediate Breast Reconstruction

Abstract

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.

Robotic Versus Conventional or Endoscopic Assisted Nipple Sparing Mastectomy and Immediate Prothesis Breast Reconstruction in the Management of Breast Cancer- A Prospectively Designed Multicenter Trial Comparing Clinical Outcomes, Medical Cost, and Patient-reported-outcomes (RCENSM-P)

“…In the current study, the overall medical costs of R-NSM were ~4000 USDs more than C-NSM and 2600 USDs more than E-NSM (Supplemental Digital Content Table 3, http://links.lww.com/SLA/E624). These findings were consistent with one study that reported an extra 1749 Euros for R-NSM compared with C-NSM 24 . Increased costs from R-NSM have been one of the most important rate-limiting factors for its widespread adoption 15 .…”

“…com/SLA/E624). These results were comparable to those of reported case studies, 12,23,24,35 meta-analyses, 27 and RCT. 29 In our study, a higher C-D classification grade 3 complication rate was noted in the C-NSM (13.7%) group than in the E-NSM (4.8%) and R-NSM (2.6%, P = 0.02, Supplemental Digital Content Table 2, http://links.lww.com/SLA/E624) groups.…”

“…Retrospective studies have compared E-NSM with C-NSM, 12,19–21 R-NSM with C-NSM, 22–27 and R-NSM with E-NSM 12,28 . A prospective randomized clinical trial (RCT) 29 directly compared the clinical results and patient-reported outcome measures (PROMs) of R-NSM with C-NSM.…”

Robotic-Assisted Nipple Sparing Mastectomy

“…9,20,39,40,42,45,[51][52][53][54] Comparison studies between R-NSM, E-NSM, and open NSM have shown that R-NSM takes longer than either E-NSM or open NSM on average; however, other studies have shown that after 10 to 12 attempts, total operative time for R-NSM was similar to open NSM. 38,45,55,56 Perioperative complications are similar for NSM, regardless of the technique used. Most studies on R-NSM reported outcomes including major complications (reoperation, implant loss, and conversion to open technique), minor complications (transient neuropathy, hematoma, seroma, thermal injury, eschar formation, mastectomy flap, or NAC necrosis), postoperative pain, and hospital length of stay.…”

“…In studies comparing R-NSM to either E-NSM or open NSM, no significant differences in overall complication rates were observed. 38,55,56 When assessing the complication profiles for R-NSM, it is important to note that all studies included various additional reconstructive procedures (e.g., direct to implant reconstruction, tissue expander placement, latissimus dorsi harvest, and contralateral symmetrizing procedures) which can make it difficult to determine specifically whether the complication is attributed to the R-NSM procedure itself or the associated procedures. Since R-NSM is an emerging technique with relatively short follow-up, there is a paucity of data on oncological outcomes for breast surgery patients undergoing this procedure.…”