51
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Lai HW, Chen ST, Mok CW, Lin YJ, Wu HK, Lin SL, Chen DR, Kuo SJ. 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. J Plast Reconstr Aesthet Surg 2020; 73:1514-1525. [PMID: 32238306 DOI: 10.1016/j.bjps.2020.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/01/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Robotic nipple sparing mastectomy (R-NSM), which uses the da Vinci surgical platform, could perform NSM and immediate breast reconstruction through a small and inconspicuous extra-mammary axillary or lateral chest incision. R-NSM was reported with extremely low nipple areolar complex (NAC) necrosis rate, good cosmetic results, and high patient satisfaction. However, there was little evidence available comparing the effectiveness and safety of R-NSM and conventional NSM (C-NSM) in the management of breast cancer. METHODS A case control comparison study was conducted for patients with breast cancer who underwent R-NSM or C-NSM with immediate gel implant breast reconstruction (IGBR) from July 2011 to September 2019 at a single institution to compare the clinical outcomes, patient-reported esthetic results, and medical cost. RESULTS According to the study design, 54 procedures of R-NSM were compared with 62 procedures of C-NSM in the surgical management of breast cancer combined with IGBR. Compared with C-NSM, R-NSM was associated with higher overall satisfaction (92% excellent and 8% good versus 75.6% excellent and 24.4% good, P = 0.046), and wound/scar related outcome in patient-reported esthetic results. The NAC ischemia/necrosis risk, overall complication rate, and blood loss were not significantly different between R-NSM and C-NSM groups. However, longer operation time and higher overall medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P<0.01) was observed in R-NSM group. CONCLUSION Compared with C-NSM, R-NSM showed comparable clinical outcomes and favorable patients' satisfaction with the esthetic results, but at the price of longer operation time and higher cost.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan; Minimal invasive surgery research center, Changhua Christian Hospital, Changhua, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Chang Gung University College of Medicine, Taoyuan City, Taiwan; Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Shou-Tung Chen
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore; Singhealth Duke-NUS Breast Centre, Singapore.
| | - Ying-Jen Lin
- Tumor Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Hwa-Koon Wu
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan.
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
| | - Dar-Ren Chen
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Shou-Jen Kuo
- Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan; Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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52
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Lai HW, Chen ST, Tai CM, Lin SL, Lin YJ, Huang RH, Mok CW, Chen DR, Kuo SJ. Robotic- Versus Endoscopic-Assisted Nipple-Sparing Mastectomy with Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Case-Control Comparison Study with Analysis of Clinical Outcomes, Learning Curve, Patient-Reported Aesthetic Results, and Medical Cost. Ann Surg Oncol 2020; 27:2255-2268. [PMID: 32016631 DOI: 10.1245/s10434-020-08223-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND New surgical innovations of nipple-sparing mastectomy (NSM), such as endoscopic NSM (E-NSM) or robotic NSM (R-NSM), were emerging. However, there was a lack of evidence comparing the effectiveness and safety in the management of breast cancer. METHODS A case-control comparison study was conducted for patients with breast cancer underwent E-NSM or R-NSM with immediate prosthesis breast reconstruction (IPBR) from July 2010 to February 2019 at a single institution to compare the clinical outcomes, learning curve, patient-reported cosmetic results, and medical cost. RESULTS A total of 91 E-NSM and 40 R-NSM procedures were retrieved and analyzed. The surgical margin involvement rate in both R-NSM (2.5%) and E-NSM (4.4%) procedures were relatively low (P = 0.52). The R-NSM group was associated with higher satisfaction rates in terms of scar appearance, scar length, and surgical wound position compared with the E-NSM group. Compared with E-NSM, the R-NSM operation time took longer (241 ± 61 vs. 215 ± 70 min, P = 0.01), less blood loss (32 ± 29 vs. 79 ± 62 ml, P < 0.01), and higher medical cost (10,587 ± 554 vs. 6855 ± 936 U.S. dollars, P < 0.01). There was no statistically significant difference in nipple ischemia/necrosis or overall complication between R-NSM and E-NSM. In the learning curve analysis, it took the 27th procedure in E-NSM and 10th procedure in R-NSM to decrease operation time significantly. CONCLUSIONS R-NSM was associated with higher wound-related satisfaction, lesser blood loss, and shorter learning curve compared with E-NSM, however, at the price of longer operation time and higher medical cost.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. .,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. .,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. .,Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan. .,School of Medicine, National Yang Ming University, Taipei, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan. .,Chang Gung University College of Medicine, Taoyuan City, Taiwan. .,Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Shou-Tung Chen
- Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Mei Tai
- Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.,Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Jen Lin
- Tumor Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ren-Hung Huang
- Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore.,Singhealth Duke-NUS Breast Center, Singapore, Singapore
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Jen Kuo
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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53
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Donnely E, Griffin MF, Butler PE. Robotic Surgery: A Novel Approach for Breast Surgery and Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2578. [PMID: 32095394 PMCID: PMC7015621 DOI: 10.1097/gox.0000000000002578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Breast cancer is the most prevalent cancer and second leading cause of cancer-related deaths in both the US and UK female population, a prominent cause of morbidity and cost to both health services. All surgically fit patients are offered breast reconstruction following the initial surgery, and this is traditionally an open approach: either implant-based or an autologous tissue flap. Both lead to scarring that is difficult to conceal. This paper aims to evaluate the novel minimally invasive technique of robotic-assisted surgery. Methods: A systematic review was conducted using Medline (OvidSP) and Embase (OvidSP) to evaluate the current application of robotic-assisted surgery in breast surgery and reconstruction. Results: Twenty-one articles were identified and discussed, composing of level 4 and 5 evidence comparing different surgeons' experiences, techniques, and outcomes. To date, the robotic system has been utilized to harvest the latissimus dorsi muscle for use as a tissue flap (total harvest time of 92 minutes), to perform nipple-sparing mastectomy with immediate breast reconstruction (total operation time 85 minutes) and lately to harvest a deep inferior epigastric perforator flap via an intraabdominal approach. Conclusions: Robotic-assisted surgery can successfully and reproducibly perform a nipple-sparing mastectomy with breast reconstruction. It can minimize the size of scarring and is superior to the laparoscopic technique, with improved 3-dimensional visualization, dexterity, and range of motion able to guide around the curvature of the breast. The main limiting factors are the lack of the US Food and Drug Administration approval, cost of the robot, and specialized skills required.
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Affiliation(s)
- Edward Donnely
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Michelle F Griffin
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Peter E Butler
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
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54
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Rathat G, Herlin C, Bonnel C, Captier G, Duraes M. Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1812-1816. [PMID: 31801936 PMCID: PMC6913238 DOI: 10.12659/ajcr.919669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 45-year-old Final Diagnosis: Prophylactic mastectomy Symptoms: — Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Gauthier Rathat
- Department of Oncological Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Christian Herlin
- Department of Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Christophe Bonnel
- Innovation Extractor Department, Montpellier Hospital, University of Montpellier, Montpellier, France
| | - Guillaume Captier
- Laboratory of Anatomy, University of Montpellier, Montpellier, France
| | - Martha Duraes
- Department of Oncological Breast Surgery, Montpellier University Hospital, Montpellier, France
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55
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Mok CW, Lai HW. Evolution of minimal access breast surgery. Gland Surg 2019; 8:784-793. [PMID: 32042687 PMCID: PMC6989909 DOI: 10.21037/gs.2019.11.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/04/2019] [Indexed: 01/30/2023]
Abstract
Surgical management of breast cancer has been evolving rapidly over the past 20-30 years. Prior to this, conventional surgical options were limited to either a mastectomy or breast conserving surgery. The demand for better aesthetic outcomes had driven the development of oncoplastic breast conserving surgery where glandular rearrangement or replacement coupled with thoughtfully placed incisions became the standard approach to breast conserving surgery. As breast surgeons and patients demand for improved aesthetic outcomes, minimally invasive or minimal access breast surgery has gained much attention over the past two decades, from endoscopic assisted to robotic-assisted breast surgery more recently. However, there has been a lack of review articles discussing this relatively recent but under-reported subset of surgical techniques in the management of breast cancer. This article aims to discuss the concept and development of minimal access breast surgery along with a review of current literature on its indications, techniques and outcome measures as well as a discussion on the strengths, limitations as well as future directions. Continued improvement in techniques and advancement of technology will definitely increase the likelihood of minimal access techniques being placed as the standard of care in the management of breast cancer.
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Affiliation(s)
- Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore
- Singhealth Duke-NUS Breast Centre, Singapore, Singapore
| | - Hung-Wen Lai
- Endoscopy & Oncoplastic Breast Surgery Center, National Yang Ming University, Taipei
- Division of General Surgery, National Yang Ming University, Taipei
- Comprehensive Breast Cancer Center, National Yang Ming University, Taipei
- School of Medicine, National Yang Ming University, Taipei
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin
- Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua
- Kaohsiung Medical University, Kaohsiung
- School of Medicine, Chung Shan Medical University, Taichung
- Chang Gung University College of Medicine, Taoyuan City
- Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
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56
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Park HS, Lee J, Lee H, Lee K, Song SY, Toesca A. Development of Robotic Mastectomy Using a Single-Port Surgical Robot System. J Breast Cancer 2019; 23:107-112. [PMID: 32140275 PMCID: PMC7043949 DOI: 10.4048/jbc.2020.23.e3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022] Open
Abstract
Minimal invasive surgical technique has been increasingly applied to breast surgery. Since the first robot-assisted nipple-sparing mastectomy was introduced, we have been performing nipple-sparing mastectomy using multi-port robotic surgical system. Last year, the new robotic surgical system with single port was introduced. We report the development of a robotic nipple-sparing mastectomy with immediate reconstruction through a single incision using the updated single-port surgical robot system for a patient with ductal carcinoma in situ (DCIS). Breast reconstruction was performed using implants. Postoperative pathological examination revealed DCIS in both breasts. There were no major immediate complications, except for a minor skin burn on the right breast. Overall, the initial operation using the updated platform was safely performed.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Haemin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwanbum Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
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57
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Park HS, Lee J, Lee DW, Song SY, Lew DH, Kim SI, Cho YU. Robot-assisted Nipple-sparing Mastectomy with Immediate Breast Reconstruction: An Initial Experience. Sci Rep 2019; 9:15669. [PMID: 31666551 PMCID: PMC6821761 DOI: 10.1038/s41598-019-51744-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
Abstract
Seeking smaller and indistinct incisions, physicians have attempted endoscopic breast surgery in breast cancer patients. Unfortunately, there are some limitations in the range of movement and visualization of the operation field. Potentially addressing these limitations, we investigated the outcomes of gas and gasless robot-assisted nipple-sparing mastectomy (RANSM) with immediate breast reconstruction (IBR). Ten patients underwent 12 RANSM with IBR between November 2016 and April 2018. Patients with tumors measuring >5 cm in diameter, tumor invasion of the skin or nipple-areolar complex, proven metastatic lymph nodes, or planned radiotherapy were excluded. Age, breast weight, diagnosis, tumor size, hormone receptor status, and operation time were retrospectively collected. Postoperative outcomes including postoperative complications and final margin status of resected were analyzed. The median total operation time and console time were 351 min (267–480 min) and 51 min (18–143 min), respectively. The learning curve presented as a cumulative sum graph showed that the console time decreased and then stabilized at the eighth case. There was no open conversion or major postoperative complication. One patient had self-resolved partial nipple ischemia, and two patients experienced partial skin ischemia. We deemed that RANSM with IBR is safe and feasible for early breast cancer, benign disease of the breast, and BRCA 1/2 mutation carriers. RANSM is an advanced surgical method with a short learning curve.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong Won Lee
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstruction Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Up Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
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58
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Single-port 3-dimensional Videoscope-assisted Endoscopic Nipple-sparing Mastectomy in the Management of Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2367. [PMID: 31592384 PMCID: PMC6756665 DOI: 10.1097/gox.0000000000002367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. The preliminary experience and results of an innovative surgical technique that incorporated a single-port and 3-dimensional (3D) videoscope system for endoscopic nipple-sparing mastectomy (E-NSM) were reported. The medical records of patients who underwent single-port 3D E-NSM for breast cancer during the period of August 2018 to October 2018 in a single institution were collected prospectively and analyzed. Patients’ reported cosmetic outcome results were also obtained. During the study period, 11 patients received 15 procedures of single-port 3D E-NSM. The mean operation time for single-port 3D E-NSM and immediate prosthesis breast reconstruction was 181.8 ± 32.4 minutes. The mean blood loss was 38.3 ± 45.3 ml (15–60). In the postoperative morbidity evaluation, 1 patient (6.7%) had delayed axillary wound healing and 2 (13.4%) had transient nipple ischemia, but there were no cases of total nipple areolar complex necrosis and implant loss observed. In addition, there were no cases with margin involvement or locoregional recurrence during the follow-up period. In patient-reported cosmetic outcomes, high (93.3%) satisfaction rates were observed in terms of postoperative scar appearance, location, and length. All patients who had received 3D E-NSM and immediate prosthesis breast reconstruction reported that they would choose the same operation again if given the chance to do so. From our preliminary experience, single-port 3D E-NSM is a feasible and safe procedure with good cosmetic results. Hence, this technique could be a promising new technique for patients with breast cancer indicated for nipple-sparing mastectomy.
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Toesca A, Invento A, Massari G, Girardi A, Peradze N, Lissidini G, Sangalli C, Maisonneuve P, Manconi A, Gottardi A, Baker JL, Bottiglieri L, Naninato P, Farante G, Magnoni F, De Scalzi A, Corso G, Colleoni M, De Lorenzi F, Sacchini V, Galimberti V, Intra M, Rietjens M, Veronesi P. Update on the Feasibility and Progress on Robotic Breast Surgery. Ann Surg Oncol 2019; 26:3046-3051. [PMID: 31342391 DOI: 10.1245/s10434-019-07590-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Robotic nipple-sparing mastectomy (RNSM) may allow for more precise anatomic dissection and improved cosmetic outcomes over conventional open nipple-sparing mastectomy; however, data regarding the feasibility and safety of the procedure are limited. OBJECTIVE The aim of this study was to present and discuss perioperative surgical outcomes and early oncologic follow-up data on consecutive patients undergoing RNSM from June 2014 to January 2019. METHODS Patients underwent RNSM and immediate robotic breast reconstruction through an axillary incision at a single institution. Perioperative data, complications at 3 months postoperatively, pathological data, and adjuvant therapies were recorded. Local recurrence-free, disease-free, and overall survival were analyzed. RESULTS Overall, 73 women underwent 94 RNSM procedures. Indications were invasive breast cancer in 39 patients, ductal carcinoma in situ in 17 patients, and BRCA mutation in 17 patients. Mean surgery time was 3 h and 32 min. One-step reconstruction with implant occurred in 89.4% of procedures. The rate of complications requiring reoperation was 4.3%, and the rate of flap or nipple necrosis was 1.1%. Median follow-up was 19 months (range 3.1-44.8). No local recurrences occurred. Overall survival at 12, 24, or 60 months was 98% (95% confidence interval 86-100%). CONCLUSION We observed a low complication rate in 94 consecutive RNSM procedures, demonstrating the procedure is technically feasible and safe. We found no early local failures at 19 months follow-up. Long-term follow-up is needed to confirm oncologic safety. Future clinical trials to study the advantages and disadvantages of RNSM are warranted.
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Affiliation(s)
- Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.
| | - Alessandra Invento
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Massari
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonia Girardi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Nickolas Peradze
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Germana Lissidini
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudia Sangalli
- Data Management, European Institute of Oncology IRCCS, Milan, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Manconi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessandra Gottardi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Jennifer L Baker
- Breast Surgery Division, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Luca Bottiglieri
- Division of Pathology, European Institute of Oncology IRCC, Milan, Italy
| | - Paola Naninato
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriel Farante
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Virgilio Sacchini
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.,Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,University of Milan School of Medicine, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mario Rietjens
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.,University of Milan School of Medicine, Milan, Italy
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Lai HW, Wang CC, Lai YC, Chen CJ, Lin SL, Chen ST, Lin YJ, Chen DR, Kuo SJ. The learning curve of robotic nipple sparing mastectomy for breast cancer: An analysis of consecutive 39 procedures with cumulative sum plot. Eur J Surg Oncol 2019; 45:125-133. [DOI: 10.1016/j.ejso.2018.09.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/09/2018] [Accepted: 09/17/2018] [Indexed: 12/24/2022] Open
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Lai HW, Chen CY, Mok C, Liao CY, Chen CJ, Chen ST, Lin SL, Chen DR, Kuo SJ. Robotic nipple-sparing mastectomy: A preliminary report of a single institute and joint collective analysis of current reported series. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_117_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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62
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Lai HW. Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction with Gel Implant. Ann Surg Oncol 2018; 26:53-54. [DOI: 10.1245/s10434-018-6711-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 11/18/2022]
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