Hyung Seok Park1, Jeea Lee2, Hung-Wen Lai3,4,5, Jung Mi Park6, Jai Min Ryu7, Jeong Eon Lee7, Jee Ye Kim1, Emilia Marrazzo8, Alessandra Margherita De Scalzi9, Giovanni Corso9,10, Filippo Montemurro11, Guglielmo Gazzetta11, Giada Pozzi11, Antonio Toesca12. 1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Gyeonggi-do, Korea. 3. Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan. 4. Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan. 5. Kaohsiung Medical University, Kaohsiung, Taiwan. 6. Department of Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Korea. 7. Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 8. Breast Unit, Department of Surgery, Ospedale Maggiore di Lodi, ASST di Lodi, Lodi, Italy. 9. Division of Breast Surgery, School of Medicine, European Institute of Oncology IRCCS, University of Milan, Milan, Italy. 10. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 11. Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy. 12. Breast Surgery Strategic Program, Candiolo Cancer Institute, FPO - IRCCS, Str. Provinciale 142, Candiolo, Torino, Italy. antonio.toesca@libero.it.
Abstract
BACKGROUND: Robotic nipple-sparing mastectomy (RNSM) has been developed to reduce conspicuous scar and increase the quality of life in women. This study aimed to evaluate the surgical and oncologic outcomes of RNSM with immediate breast reconstruction (IBR) compared with conventional nipple-sparing mastectomy (CNSM). PATIENTS AND METHODS: This international multicenter, pooled analysis of individual patient-level data enrolled a total of 755 procedures in 659 women (609 had breast cancer and 50 underwent risk-reducing mastectomy) who underwent nipple-sparing mastectomy with IBR. Surgical and oncologic outcomes, including 30-days postoperative (POD 30d) complication rate, nipple necrosis rate, grade of Clavien-Dindo classification, disease-free survival, and overall survival, were evaluated. Propensity score-matched analyses were performed to adjust for confounding factors. RESULTS: The median age of both the RNSM and CNSM groups was 45 years. The RNSM group had lower body mass index (BMI) and a higher proportion of benign disease compared with the CNSM group. POD 30d complications and postoperative complication grade III rates were lower in the RNSM group than in the CNSM group (p < 0.05). The nipple necrosis rate was 2.2% and 7.8% for RNSM and CNSM, respectively (p = 0.002). After propensity score matching, significantly lower rates of POD 30d complications, nipple necrosis, and postoperative complication grade III occurred in the RNSM group than in the CNSM group (all p < 0.05). Oncologic outcomes were not significantly different between the two groups. CONCLUSION: RNSM can provide better cosmetic results with favorable surgical and oncologic outcomes for women with early breast cancer or BRCA mutation.
BACKGROUND: Robotic nipple-sparing mastectomy (RNSM) has been developed to reduce conspicuous scar and increase the quality of life in women. This study aimed to evaluate the surgical and oncologic outcomes of RNSM with immediate breast reconstruction (IBR) compared with conventional nipple-sparing mastectomy (CNSM). PATIENTS AND METHODS: This international multicenter, pooled analysis of individual patient-level data enrolled a total of 755 procedures in 659 women (609 had breast cancer and 50 underwent risk-reducing mastectomy) who underwent nipple-sparing mastectomy with IBR. Surgical and oncologic outcomes, including 30-days postoperative (POD 30d) complication rate, nipple necrosis rate, grade of Clavien-Dindo classification, disease-free survival, and overall survival, were evaluated. Propensity score-matched analyses were performed to adjust for confounding factors. RESULTS: The median age of both the RNSM and CNSM groups was 45 years. The RNSM group had lower body mass index (BMI) and a higher proportion of benign disease compared with the CNSM group. POD 30d complications and postoperative complication grade III rates were lower in the RNSM group than in the CNSM group (p < 0.05). The nipple necrosis rate was 2.2% and 7.8% for RNSM and CNSM, respectively (p = 0.002). After propensity score matching, significantly lower rates of POD 30d complications, nipple necrosis, and postoperative complication grade III occurred in the RNSM group than in the CNSM group (all p < 0.05). Oncologic outcomes were not significantly different between the two groups. CONCLUSION: RNSM can provide better cosmetic results with favorable surgical and oncologic outcomes for women with early breast cancer or BRCA mutation.
Authors: Antonio Toesca; Alessandra Invento; Giulia Massari; Antonia Girardi; Nickolas Peradze; Germana Lissidini; Claudia Sangalli; Patrick Maisonneuve; Andrea Manconi; Alessandra Gottardi; Jennifer L Baker; Luca Bottiglieri; Paola Naninato; Gabriel Farante; Francesca Magnoni; Alessandra De Scalzi; Giovanni Corso; Marco Colleoni; Francesca De Lorenzi; Virgilio Sacchini; Viviana Galimberti; Mattia Intra; Mario Rietjens; Paolo Veronesi Journal: Ann Surg Oncol Date: 2019-07-24 Impact factor: 5.344
Authors: Antonio Toesca; Nickolas Peradze; Andrea Manconi; Viviana Galimberti; Mattia Intra; Marco Colleoni; Bernardo Bonanni; Giuseppe Curigliano; Mario Rietjens; Giuseppe Viale; Virgilio Sacchini; Paolo Veronesi Journal: Breast Date: 2016-11-02 Impact factor: 4.380