Endoscopy-assisted breast conservation surgery (E-BCS) vs conventional breast conservation surgery (C-BCS) technique for the management of early breast cancer: A systematic review and meta-analysis

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BACKGROUND: Endoscopy-assisted breast conserving surgery (E-BCS) was developed over 10 years ago as a method for breast cancer treatment with the potential advantage of less noticeable scarring. However, the evidence supporting its superiority over conventional breast conserving surgery (C-BCS) remains unclear. OBJECTIVE: This study aims to compare the outcomes of E-BCS and C-BCS for the treatment of early breast cancer. METHODS: A comprehensive search for relevant articles was performed using specific keywords in Medline, Scopus, ClinicalTrials.gov, and Cochrane Library PubMed up to October 17th, 2022. Clinical trials that compared E-BCS with C-BCS in early breast cancer patients were collected. RESULTS: Our analysis of nine studies revealed that E-BCS was associated with shorter incision length [Mean Difference (MD) −6.50 cm (95% CI −10.75, −2.26), p = 0.003, I2 = 99%] and higher cosmetic score [MD 2.69 (95% CI 1.46, 3.93), p < 0.0001, I2 = 93%] compared with C-BCS. However, E-BCS had a longer operation time [MD 35.95 min (95% CI 19.12, 52.78), p < 0.0001, I2 = 93%] and greater drainage volume [MD 62.91 mL (95% CI 2.55, 123.27), p = 0.04, I2 = 79%]. There was no significant difference in blood loss volume (p = 0.06), drainage duration (p = 0.28), postoperative complications (p = 0.69), or local recurrence (p = 0.59) between the two groups. CONCLUSION: Our study suggests that E-BCS offers a shorter incision length and better cosmetic outcome compared with C-BCS in the treatment of early breast cancer. However, E-BCS requires a longer operation time and has greater drainage volume. Further studies are needed to confirm these findings.