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; Ying-Jen Lin; Shih-Lung Lin; Ching-Min Lin; Dar-Ren Chen; Shou-Jen Kuo

doi:10.3389/fonc.2021.739144

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

Front Oncol. 2021 Nov 19:11:739144. doi: 10.3389/fonc.2021.739144. eCollection 2021.

Authors

Hung-Wen Lai^{1

2

3

4

5

6

7

8

9

10}, Shou-Tung Chen^{1

2

3}, Ying-Jen Lin¹¹, Shih-Lung Lin¹², Ching-Min Lin^{2

5}, Dar-Ren Chen^{1

2

3}, Shou-Jen Kuo^{1

2

3}

Affiliations

¹ Endoscopic and Oncoplastic Breast Surgery Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
² Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
³ Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁴ Minimal Invasive Surgery Research Center, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁵ Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Division of Breast Surgery, Department of Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
⁷ Department of Surgery, School of Medicine, National Yang Ming University, Taipei, Taiwan.
⁸ Department of Surgery, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁹ Department of Surgery, Chang Gung University College of Medicine, Taoyuan City, Taiwan.
¹⁰ Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹¹ Tumor Center, Changhua Christian Hospital, Changhua, Taiwan.
¹² Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.

Abstract

Objective: Endoscopic 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.

Methods: Information 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).

Results: A 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.

Conclusion: MABS 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.

Keywords: conventional breast surgery (CBS); endoscopic assisted nipple sparing mastectomy (E-NSM); endoscopy-assisted breast conserving surgery (E-BCS); endoscopy-assisted breast surgery (EABS); robotic assisted nipple sparing mastectomy (R-NSM); single-port three-dimensional videoscope-assisted endoscopic nipple sparing mastectomy (3D E-NSM).