Abstract
BackgroundSeveral studies reported the feasibility and safety of robotic-NSM (R-NSM). The aim of our prospective study was to compare R-NSM and conventional-NSM (C-NSM).MethodsWe analyzed patients who were operated on with and without robotic assistance (R-NSM or C-NSM) and who received immediate breast reconstruction (IBR) with implant or latissimus dorsi-flap (LDF). The main objective was complication rate and secondary aims were post-operative length of hospitalization (POLH), duration of surgery, and cost.ResultsWe analyzed 87 R-NSM and 142 C-NSM with implant-IBR in 50 and 135 patients, with LDF-IBR in 37 and 7 patients, respectively. Higher durations of surgery and costs were observed for R-NSM, without a difference in POLH and interval time to adjuvant therapy between R-NSM and C-NSM. In the multivariate analysis, R-NSM was not associated with a higher breast complication rate (OR=0.608) and significant factors were breast cup-size, LDF combined with implant-IBR, tobacco and inversed-T incision. Grade 2-3 breast complications rate were 13% for R-NSM and 17.3% for C-NSM, significantly higher for LDF combined with implant-IBR, areolar/radial incisions and BMI>=30. A predictive score was calculated (AUC=0.754). In logistic regression, patient’s satisfaction between C-NSM and R-NSM were not significantly different, with unfavorable results for BMI >=25 (OR=2.139), NSM for recurrence (OR=5.371) and primary breast cancer with radiotherapy (OR=4.533). A predictive score was calculated. In conclusion, our study confirms the comparable clinical outcome between C- NSM and R-NSM, in the price of longer surgery and higher cost for R-NSM. Predictive scores of breast complications and satisfaction were significantly associated with factors known in the pre-operative period.
Highlights
Despite an increase in breast conservative surgery, a total mastectomy is still necessary in 12% to 30% of patients [1,2,3] in cases of extended ductal carcinoma in-situ (DCIS), invasive breast cancer (BC) with an extensive DCIS component, multifocal disease, large BC according to breast size without indication of neoadjuvant chemotherapy (NAC), prophylactic mastectomies, ipsilateral BC local recurrence (ILBCLR), non insano initial resection, and patient’s wishes
Out of 375 Nipplesparing mastectomy (NSM) performed since January 2016, 145 NSM were realized before March 2018, with 27 R-NSM reported in the preliminary experience of R-NSM
All others R-NSM-Immediate breast reconstruction (IBR) were realized with definitive breast implant (n=50) in 7 cases with pre-pectoral implant (3 prophylactic NSM and 4 for primary BC)
Summary
Despite an increase in breast conservative surgery, a total mastectomy is still necessary in 12% to 30% of patients [1,2,3] in cases of extended ductal carcinoma in-situ (DCIS), invasive breast cancer (BC) with an extensive DCIS component, multifocal disease, large BC according to breast size without indication of neoadjuvant chemotherapy (NAC), prophylactic mastectomies, ipsilateral BC local recurrence (ILBCLR), non insano initial resection, and patient’s wishes. Several studies reported a few cases of robotic-NSM (R-NSM) to evaluate feasibility, reproducibility, and safety [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]. A technical robotic surgical consensual NSM procedure was reported [28]. Comparison between R-NSM and conventional- NSM (CNSM) has been recently reported in only one retrospective study with a small sample size and for procedures realized by only one surgeon [29]. Several studies reported the feasibility and safety of robotic-NSM (R-NSM). The aim of our prospective study was to compare R-NSM and conventional-NSM (C-NSM)
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