Minimal Access (Endoscopic and Robotic) Breast Surgery in the Surgical Treatment of Early Breast Cancer-Trend and Clinical Outcome From a Single-Surgeon Experience Over 10 Years.

Hung-Wen Lai,Shou-Tung Chen,Shih-Lung Lin,Dar-Ren Chen,Shou-Jen Kuo,Ying-Jen Lin,Ching-Min Lin

doi:10.3389/fonc.2021.739144

Abstract

ObjectiveEndoscopic assisted breast surgery (EABS) or robotic assisted breast surgery (RABS) performed through minimal axillary and/or peri-areolar incisions has become the representative of minimal access breast surgery (MABS). We report the trend and clinical outcome of MABS for treatment of breast cancer.MethodsInformation on patients who underwent breast cancer operation by the principal investigator during the period of 2011 to 2020 was collected from a single institute for analysis. The clinical outcome, trend, and cost of MABS were analyzed and compared with conventional breast surgery (CBS).ResultsA total of 824 breast cancer patients operated by a single surgeon were enrolled in this study: 254 received CBS and 570 received MABS, namely, 476 EABS and 94 RABS. From 2011 to 2020, the number of MABS performed annually has shown an increasing trend. Compared with CBS, MABS such as breast conserving surgery and nipple sparing mastectomy (NSM) have effectively reduced wound scar length. Since the sequential uprise from conventional NSM (C-NSM), dual-axillary-areolar-incision two dimensional (2D) endoscopic assisted NSM (E-NSM), single-axillary-incision E-NSM, robotic assisted NSM (R-NSM), and single-port 3D E-NSM, the development of minimal access mastectomies increasingly paralleled with NSM. The operation time of various MABS decreased significantly and showed no statistical difference compared with CBS. R-NSM was associated with highest cost, followed by 3D E-NSM, E-NSM, and C-NSM. The positive surgical margin rate and local recurrence rate of MABS and CBS were not statistically different.ConclusionMABS showed comparable clinical outcome and preliminary oncologic safety as CBS and has been increasingly performed as the surgical treatment of breast cancer, especially minimal access NSM.

Highlights

Minimal invasive/access surgery has become the mainstream of surgical practice in recent decades [1,2,3]
The characteristics and clinicopathologic parameters of enrolled patients are summarized in Table 1, and types of surgeries performed are shown in flow chart and photos (Figures 1, 2)
The robotic assisted breast surgery (RABS) mainly focusing on robotic assisted nipple sparing mastectomy (NSM) (R-NSM) (92/94) related, and most of the patients received immediate gel implant breast reconstruction (IGBR)

Summary

Introduction

Minimal invasive/access surgery has become the mainstream of surgical practice in recent decades [1,2,3]. Endoscopic assisted breast surgery (EABS) [4,5,6] or robotic assisted breast surgery (RABS) [7,8,9] performed through minimal axillary and/or periareolar incisions has become the representative of minimal access breast surgery (MABS) [10]. The advantages of MABS (EABS or RABS) include shortening of operation scar while hiding it in inconspicuous locations, which optimize aesthetic outcome and patients’ satisfaction [9, 11, 15, 17]. The widespread use of MABS in the management of breast cancer is yet to be fully accepted; objections include limited working space, superficial nature of breast lesion, and relative low morbidity of breast surgery [28]. Drawbacks include longer operation time, more instruments needed, and higher medical cost [9, 17, 29] Of utter importance, the long-term oncologic outcome is rarely reported [5, 26] and not yet confirmed by large randomized trials

Methods

Results

Discussion

Conclusion