Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group.

Hung-Wen Lai,Shou-Tung Chen,Yao-Lung Kuo,Shou-Jen Kuo,Shu-Ling Chen,Dar-Ren Chen,Chin-Sheng Hung,Tsai-Wang Chang,Pei-Yi Chu

doi:10.1371/journal.pone.0150310

Hung-Wen Lai, Shou-Tung Chen + Show 7 more

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https://doi.org/10.1371/journal.pone.0150310

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Abstract

BackgroundEndoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.MethodsThe medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.ResultsA total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death.ConclusionThe preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique in the field of breast cancer.

Highlights

Modified radical mastectomy was the preferred method for treating operable breast cancer[1]
The rate of complications associated with Endoscopy-assisted breast surgery (EABS) was 15.2% and all were minor and wound-related
The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome

Summary

Introduction

Modified radical mastectomy was the preferred method for treating operable breast cancer[1]. A number of advances in surgical techniques have been made over the past few decades and breast-conserving surgery (BCS) is increasingly being used as treatment for breast cancer, especially in women with early stage disease[2, 3]. Sentinel lymph node biopsy (SLNB) is performed in most patients thereby sparing the need for axillary lymph node dissection (ALND) in clinical node negative patients[4]. Another important advancement in the field of breast surgery has been the development of oncoplastic breast surgery, a breast-conserving technique that combines wide tumor excision with immediate partial breast reconstruction using either volume displacement or volume replacement techniques[5, 6]. We report the early results of an EABS program in Taiwan

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Conclusion