Abstract P3-21-02: Robotic nipple sparing mastectomy in the management of breast cancer and prophylactic surgeries with SP system

Abstract

Abstract Background: Robot-assisted nipple-sparing mastectomy (R-NSM) improves cosmetic outcomes over conventional nipple-sparing mastectomy (CNSM). However, data on the feasibility and safety of the R-NSM are limited. The aim of this study was to present the results of early experience of R-NSM with SP system.Methods: Preliminary analysis of R-NSM using da Vinci SP system for breast cancer and prophylactic cases during the period October 2020 thru April 2021 from Asan Medical Center , Seoul, S Korea. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the performance and safety of R-NSM using da Vinci SP system Results: During the period October 2020 thru April 2021, a total of 41 robotic breast surgery procedures were performed in 39 female patients with breast cancer ( 35 invasive, 4 non-invasive ), and 2 patients who underwent surgery for prophylactic reasons. Five patients were bilateral and 29 were unilateral. Immediate breast reconstruction (IBR) was performed in all patients. Autologous reconstruction was performed in 16 cases, and implants were used in 23 cases. The mean age of all 41 patients was 47 years (range 31-58) and mean BMI was 23.1 (range 17.9-32.7). In two patients, neoadjuvant chemotherapy was performed before surgery. For 39 cancer cases the mean tumor size was 3.6 cm (range 0.0-8.0 cm). 14 cases had multiple tumors. Sentinel node biopsy was performed in all patients, and axillary dissection was performed in 6 cases. The pathologic stage was 12.8% DCIS, 51.3% stage I, 28.2% stage II, and 7.7 stage III. The mean operation time for R-NSM with IBR was 361 min (range 168- 788) and without IBR was 172 min ( range 80- 325). The mean hospital stay was 6.1 days (range 4-9). There were no conversions to open surgery. In three patients, nipples were removed as tumor positives from the retroareolar frozen section during surgery. The mean estimated blood loss was less than 10cc and 4 patients received transfusion but they pre-operative hemoglobin deficiency and required transfusion right after surgery. There were no procedure related reoperation and readmission and no cases of mortality during 60 day follow up period.. There were no major perioperative complications. There were 4 patient who experienced partial nipple necrosis and did not require medical intervention and were resolved. The conventional NSM method had low cosmetic satisfaction due to the enlarged skin incision on the front of the breast. When the incision is made smaller, the surgical field of view is narrow and it is difficult to perform precise surgery due to difficulty in the surgical procedure. Conclusion: From our preliminary experience, R-NSM alone or combined with IBR is a safe procedure, with clinical outcomes results, and is promising new technology for breast cancer patients indicated for mastectomy. Citation Format: Sae Byul Lee, Hyun Ho Han, Jisun Kim, BeomSeok Ko. Robotic nipple sparing mastectomy in the management of breast cancer and prophylactic surgeries with SP system [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-21-02.