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Xu X, Gao X, Pan C, Hou J, Zhang L, Lin S. Postoperative outcomes of minimally invasive versus conventional nipple-sparing mastectomy with prosthesis breast reconstruction in breast cancer: a meta-analysis. J Robot Surg 2024; 18:274. [PMID: 38951387 DOI: 10.1007/s11701-024-02030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
Breast cancer is the most common malignant tumor worldwide, and mastectomy remains the primary strategy for treating early stage breast cancer. However, the complication rates, surgical variables, and oncologic safety of minimally invasive nipple-sparing mastectomy (MINSM) have not been fully addressed. We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for randomized-controlled trials (RCTs) and non-RCTs that compared MINSM with conventional nipple-sparing mastectomy (CNSM), both followed by Prosthesis Breast Reconstruction (PBR). The main outcomes observed included overall complications, (Grade III) complications, skin and nipple necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, and oncologic safety (positive margins and recurrence). Secondary outcomes included operation time, blood loss, hospital stay, cost-effectiveness, and patient satisfaction. Binary and continuous variables were compared using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). A total of 10 studies involving 2,166 patients were included. There were no statistically significant differences between MINSM and CNSM in terms of skin necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, or oncologic safety. However, MINSM significantly reduced overall complications (OR = 0. 74, 95% CI [0. 58, 0. 94], p = 0. 01) and (Grade III) complications (OR = 0. 47, 95% CI [0. 31, 0. 71], p = 0. 0003). Nipple necrosis events were also significantly reduced in the MINSM group (OR = 0. 49, 95% CI [0. 30, 0. 80], p = 0. 005). Patient satisfaction improved notably in the MINSM group. Additionally, compared with the CNSM group, the MINSM group had longer operating times (MD = 46. 88, 95% CI [19. 55, 74. 21], p = 0. 0008) and hospital stays (MD = 1. 39, 95% CI [0. 65, 2. 12], p < 0. 001), while intraoperative blood loss was significantly reduced (MD = -29. 05, 95% CI [-36. 20, -21. 90], p < 0. 001). Compared with CNSM, MINSM offers advantages in reducing complications and intraoperative blood loss, as well as improving aesthetic outcomes and patient satisfaction. Therefore, MINSM may become a viable option for breast surgery. Nevertheless, a long-term evaluation of the oncologic safety of this approach is necessary to ensure its efficacy and safety for patients.
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Affiliation(s)
- Xia Xu
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiang Gao
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - ChaoYing Pan
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Hou
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - LinXing Zhang
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuai Lin
- Department of Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Lai HW, Chen DR, Liu LC, Chen ST, Kuo YL, Lin SL, Wu YC, Huang TC, Hung CS, Lin YJ, Tseng HS, Mok CW, Cheng FTF. Robotic Versus Conventional or Endoscopic-assisted Nipple-sparing Mastectomy and Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Prospectively Designed Multicenter Trial Comparing Clinical Outcomes, Medical Cost, and Patient-reported Outcomes (RCENSM-P). Ann Surg 2024; 279:138-146. [PMID: 37226826 PMCID: PMC10727200 DOI: 10.1097/sla.0000000000005924] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To compare the clinical and patient-reported outcomes of minimal access and conventional nipple-sparing mastectomy (C-NSM). The secondary outcomes investigated included medical costs and oncological safety. BACKGROUND Minimal-access NSM has been increasingly applied in the treatment of patients with breast cancer. However, prospective multicenter trials comparing robotic-assisted NSM (R-NSM) versus C-NSM or endoscopic-assisted NSM (E-NSM) are lacking. METHODS A prospectively designed 3-arm multicenter, nonrandomized trial (NCT04037852) was conducted from October 1, 2019 to December 31, 2021, to compare R-NSM with C-NSM or E-NSM. RESULTS A total of 73 R-NSM, 74 C-NSM, and 84 E-NSM procedures were enrolled. The median wound length and operation time of C-NSM was (9 cm, 175 minutes), (4 cm, and 195 minutes) in R-NSM, and (4 cm and 222 minutes) in E-NSM. Complications were comparable among the groups. Better wound healing was observed in the minimal-access NSM group. The R-NSM procedure was 4000 and 2600 United States Dollars more expensive than C-NSM and E-NSM, respectively. Wound/scar and postoperative acute pain evaluation favored the use of minimal access NSM over C-NSM. Quality of life in terms of chronic breast/chest pain, mobility, and range of motion of the upper extremity showed no significant differences. The preliminary oncologic results showed no differences among the 3 groups. CONCLUSIONS R-NSM or E-NSM is a safe alternative if compared with C-NSM in terms of perioperative morbidities, especially with better wound healing. The advantage of minimal access groups was higher wound-related satisfaction. Higher costs remain one of the major limiting factors in the widespread adoption of R-NSM.
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Affiliation(s)
- Hung-Wen Lai
- Department of Surgery, Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Minimal invasive surgery research center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Breast Surgery, Department of Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan
- Division of Surgery, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Breast Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Liang-Chih Liu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, Breast Medical Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Lung Kuo
- Breast Medical Center, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Surgery, College of Medicine, National Cheng Kung University and National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Chung Wu
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Chun Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Sheng Hung
- Division of Breast Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, College of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Jen Lin
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Hsin-Shun Tseng
- Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Surgery, Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chi Wei Mok
- Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Fiona Tsui-Fen Cheng
- Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
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Burns HR, McCarter JH, King BW, Yu JZ, Hwang RF. Robotic-Assisted Nipple Sparing Mastectomy. Semin Plast Surg 2023; 37:176-183. [PMID: 38444956 PMCID: PMC10911906 DOI: 10.1055/s-0043-1771047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Minimally invasive approaches to breast surgery have evolved from endoscopic techniques to recent developments in robotic-assisted mastectomies. Initial studies on robotic-assisted nipple-sparing mastectomy (RNSM) have shown improved patient satisfaction and aesthetic outcomes with similar complication rates and oncological outcomes in selected patients. This chapter reviews techniques used and available data on complications and clinical outcomes for RNSM. Currently, RNSM is an investigational technique in the United States and should be performed in clinical trials with U.S. Food & Drug Administration approval to rigorously evaluate the safety and effectiveness of this approach.
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Affiliation(s)
- Heather R. Burns
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jacob H. McCarter
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Brody W. King
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z. Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rosa F. Hwang
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Park KU, Cha C, Pozzi G, Kang YJ, Gregorc V, Sapino A, Gazzetta G, Marrazzo E, Toesca A. Robot-assisted Nipple Sparing Mastectomy: Recent Advancements and Ongoing Controversies. CURRENT BREAST CANCER REPORTS 2023; 15:127-134. [PMID: 37293274 PMCID: PMC10133895 DOI: 10.1007/s12609-023-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
Purpose of review The purpose of this review is to summarize the recent technical advancements in RNSM, describe the ongoing teaching programs, and discuss the ongoing controversies. Recent findings Robot-assisted nipple sparing mastectomy (RNSM) is the newest addition to the armamentarium of surgical techniques for patients who require a mastectomy. The potential benefits of using the da Vinci® Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) are the small 3D camera and lighting offering superior visualization, the Endowrist robotic instruments offering greater range of motion, and surgeon being at a seated position at the console rendering a more ergonomic operating position. Summary RNSM can potentially help overcome the technical difficulties of performing a conventional NSM. Further studies are needed to elucidate the oncologic safety and cost-effectiveness of RNSM.
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Affiliation(s)
- Ko Un Park
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Breast Oncology Program, Dana-Farber Brigham Cancer Center, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215 USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH USA
| | - Chihwan Cha
- Department of Surgery, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Giada Pozzi
- Division of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (To), Italy
| | - Young-Joon Kang
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Vanesa Gregorc
- Department of Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (To), Italy
| | - Anna Sapino
- Unit of Pathology, Candiolo Cancer Institute, FPO-IRCCS, Department of Medical Science, University of Turin, Turin, Italy
| | - Guglielmo Gazzetta
- Division of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (To), Italy
| | - Emilia Marrazzo
- Breast Unit, Department of Surgery, Ospedale Maggiore Di Lodi, Lodi, Italy
| | - Antonio Toesca
- Division of Breast Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (To), Italy
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Teller P, Nguyen TT, Tseng J, Allen L, Matsen CB, Bellavance E, Kaufman D, Hieken T, Nagel S, Patten C, Pomerenke L, Tevis SE, Sarantou T. Innovation in Breast Surgery: Practical and Ethical Considerations. Ann Surg Oncol 2022; 29:6144-6150. [PMID: 35854028 DOI: 10.1245/s10434-022-12136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/02/2022] [Indexed: 12/18/2022]
Abstract
The adoption of innovation is essential to the evolution of patient care. Breast surgical oncology advances through incorporating new techniques, devices, and procedures. Historical changes in practice standards from radical to modified radical mastectomy or axillary node dissection to sentinel node biopsy reduced morbidity without sacrifice in oncologic outcome. Contemporary oncoplastic techniques afford broader consideration for breast conservation and the potential for improved cosmetic outcomes. At present, many breast surgeons face the decision of which wireless device to use for localization of nonpalpable lesions. Consideration for future changes, such as robotic mastectomy, are on the horizon. No guideline exists to assist breast surgeons in the adoption of innovation into practice. The Ethics Committee of the American Society of Breast Surgeons acknowledges that breast surgeons confront many questions associated with onboarding innovation. This paper aims to provide a framework for asking relevant questions along with the ethical principles to consider when integrating an innovation into practice.
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Affiliation(s)
| | | | | | - Lisa Allen
- Capital Health Center for Comprehensive Breast Care, Pennington, NJ, USA
| | - Cindy B Matsen
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | - Tina Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven Nagel
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Caitlin Patten
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Terry Sarantou
- Department of General Surgery, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
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Micha JP, Rettenmaier MA, Bohart RD, Goldstein BH. Robotic-Assisted Surgery for the Treatment of Breast and Cervical Cancers. JSLS 2022; 26:JSLS.2022.00014. [PMID: 35815331 PMCID: PMC9215693 DOI: 10.4293/jsls.2022.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Robotic-assisted surgery facilitates the performance of numerous, complex procedures, namely conferring precision, flexibility, and control that is otherwise unavailable with conventional laparoscopy; and compared to open surgery, robotic-assisted surgery is ostensibly associated with fewer complications, reduced intraoperative complications, and shorter hospital stay duration. Nevertheless, the American College of Obstetricians and Gynecologists and the Food and Drug Administration have criticized the pervasive acceptance of robotic-assisted surgery, given the absence of randomized clinical trial data compared to traditional laparoscopy and open procedures, not to mention the increased surgical cost. Conclusions: While the research data continue to be borne out, surgeons should exercise considerable discretion in selecting the surgical approach from which their patients would derive the greatest clinical benefit.
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Affiliation(s)
- John P Micha
- Women's Cancer Research Foundation, Newport Beach, CA
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