Hung-Wen Lai1,2,3,4,5,6,7,8,9,10, Shou-Tung Chen11,12,13, Chin-Mei Tai11,13,14, Shih-Lung Lin15, Ying-Jen Lin16, Ren-Hung Huang17, Chi Wei Mok18,19, Dar-Ren Chen12,13, Shou-Jen Kuo12,13. 1. Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. 143809@cch.org.tw. 2. Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. 143809@cch.org.tw. 3. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. 143809@cch.org.tw. 4. Kaohsiung Medical University, Kaohsiung, Taiwan. 143809@cch.org.tw. 5. Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan. 143809@cch.org.tw. 6. School of Medicine, National Yang Ming University, Taipei, Taiwan. 143809@cch.org.tw. 7. School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 143809@cch.org.tw. 8. Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan. 143809@cch.org.tw. 9. Chang Gung University College of Medicine, Taoyuan City, Taiwan. 143809@cch.org.tw. 10. Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 143809@cch.org.tw. 11. Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan. 12. Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan. 13. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan. 14. Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan. 15. Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan. 16. Tumor Center, Changhua Christian Hospital, Changhua, Taiwan. 17. Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan. 18. Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore. 19. Singhealth Duke-NUS Breast Center, Singapore, Singapore.
Abstract
BACKGROUND: New surgical innovations of nipple-sparing mastectomy (NSM), such as endoscopic NSM (E-NSM) or robotic NSM (R-NSM), were emerging. However, there was a lack of evidence comparing the effectiveness and safety in the management of breast cancer. METHODS: A case-control comparison study was conducted for patients with breast cancer underwent E-NSM or R-NSM with immediate prosthesis breast reconstruction (IPBR) from July 2010 to February 2019 at a single institution to compare the clinical outcomes, learning curve, patient-reported cosmetic results, and medical cost. RESULTS: A total of 91 E-NSM and 40 R-NSM procedures were retrieved and analyzed. The surgical margin involvement rate in both R-NSM (2.5%) and E-NSM (4.4%) procedures were relatively low (P = 0.52). The R-NSM group was associated with higher satisfaction rates in terms of scar appearance, scar length, and surgical wound position compared with the E-NSM group. Compared with E-NSM, the R-NSM operation time took longer (241 ± 61 vs. 215 ± 70 min, P = 0.01), less blood loss (32 ± 29 vs. 79 ± 62 ml, P < 0.01), and higher medical cost (10,587 ± 554 vs. 6855 ± 936 U.S. dollars, P < 0.01). There was no statistically significant difference in nipple ischemia/necrosis or overall complication between R-NSM and E-NSM. In the learning curve analysis, it took the 27th procedure in E-NSM and 10th procedure in R-NSM to decrease operation time significantly. CONCLUSIONS: R-NSM was associated with higher wound-related satisfaction, lesser blood loss, and shorter learning curve compared with E-NSM, however, at the price of longer operation time and higher medical cost.
BACKGROUND: New surgical innovations of nipple-sparing mastectomy (NSM), such as endoscopic NSM (E-NSM) or robotic NSM (R-NSM), were emerging. However, there was a lack of evidence comparing the effectiveness and safety in the management of breast cancer. METHODS: A case-control comparison study was conducted for patients with breast cancer underwent E-NSM or R-NSM with immediate prosthesis breast reconstruction (IPBR) from July 2010 to February 2019 at a single institution to compare the clinical outcomes, learning curve, patient-reported cosmetic results, and medical cost. RESULTS: A total of 91 E-NSM and 40 R-NSM procedures were retrieved and analyzed. The surgical margin involvement rate in both R-NSM (2.5%) and E-NSM (4.4%) procedures were relatively low (P = 0.52). The R-NSM group was associated with higher satisfaction rates in terms of scar appearance, scar length, and surgical wound position compared with the E-NSM group. Compared with E-NSM, the R-NSM operation time took longer (241 ± 61 vs. 215 ± 70 min, P = 0.01), less blood loss (32 ± 29 vs. 79 ± 62 ml, P < 0.01), and higher medical cost (10,587 ± 554 vs. 6855 ± 936 U.S. dollars, P < 0.01). There was no statistically significant difference in nipple ischemia/necrosis or overall complication between R-NSM and E-NSM. In the learning curve analysis, it took the 27th procedure in E-NSM and 10th procedure in R-NSM to decrease operation time significantly. CONCLUSIONS: R-NSM was associated with higher wound-related satisfaction, lesser blood loss, and shorter learning curve compared with E-NSM, however, at the price of longer operation time and higher medical cost.
Authors: Olivia Quilichini; Julien Barrou; Marie Bannier; Sandrine Rua; Aurore Van Troy; Laura Sabiani; Eric Lambaudie; Monique Cohen; Gilles Houvenaeghel Journal: Ann Med Surg (Lond) Date: 2020-12-31