Oncologic Outcome of Endoscopic Assisted Breast Surgery Compared with Conventional Approach in Breast Cancer: An Analysis of 3426 Primary Operable Breast Cancer Patients from Single Institute with and Without Propensity Score Matching

Lai, Hung-Wen; Chen, Shou‐Tung; Liao, Chiung-Ying; Mok, Chi Wei; Lin, Ying-Jen; Chen, Dar‐Ren; Kuo, Shou‐Jen

doi:10.1245/s10434-021-09950-8

Cited by 17 publications

(17 citation statements)

References 36 publications

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“…Luo et al found no significant difference in DFS (64.5% vs 60.8%; P = .88) and OS (81.7% vs 78.6%; P = .95) between groups undergoing mastoscopic axillary lymph node dissection vs completion axillary lymph node dissection. Lai et al reported a difference in OS between endoscope-assisted breast surgery and conventional surgery groups before propensity score matching but this difference was no longer significant after propensity score matching. In a comparison of endoscopic nipple-sparing mastectomy and immediate implant reconstruction with breast-conserving surgery, DFS and OS in the breast-conserving surgery group were lower than those in the endoscopic-assisted nipple-sparing mastectomy group, but the difference did not show statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

et al. 2022

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ImportanceMinimal access breast surgery (MABS) has been used in breast cancer management. However, long-term prognostic data associated with MABS vs conventional breast surgery (CBS) are lacking.ObjectiveTo investigate long-term therapeutic outcomes associated with MABS vs CBS for breast cancer management.Design, Setting, and ParticipantsIn this single-center retrospective cohort study, 9184 individuals were assessed for inclusion. After exclusions, 2412 adult female individuals were included who were diagnosed with stage 0 to III breast cancer, underwent unilateral breast surgery between January 2004 and December 2017, and had no distant metastasis or history of severe underlying disease. Propensity score matching was performed to minimize selection bias. Data were analyzed from January 1, 2004, to December 31, 2019.ExposuresMABS or CBS.Main Outcomes and MeasuresData on demographic and tumor characteristics and long-term outcomes were collected and analyzed.ResultsThis study included 2412 patients (100% female; median [IQR] age, 44 [40-49] years). Of these, 603 patients underwent MABS (endoscopic, endoscopy-assisted, or robot-assisted procedures in 289, 302, and 12 patients, respectively) and 1809 patients underwent CBS. The median follow-up time was 84 months (93 in the MABS group and 80 months in the CBS group). Intergroup differences were not significant for the following parameters: 10-year local recurrence-free survival (93.3% vs 96.3%; hazard ratio [HR], 1.39; 95% CI, 0.86-2.27; P = .18), regional recurrence-free survival (95.5% vs 96.7%; HR, 1.38; 95% CI, 0.81-2.36; P = .23), and distant metastasis-free survival (81.0% vs 82.0%; HR, 0.95; 95% CI, 0.74-1.23; P = .72). The 5-, 10-, and 15-year disease-free survival rates in the MABS group were 85.9%, 72.6%, and 69.1%, respectively. The corresponding rates in the CBS group were 85.0%, 76.6%, and 70.7%. The intergroup differences were not significant (HR, 1.07; 95% CI, 0.86-1.31; P = .55). The 5-, 10-, and 15-year overall survival rates in the MABS group were 92.0%, 83.7%, and 83.0%, respectively. The corresponding rates in the CBS group were 93.6%, 88.7%, and 81.0%. The intergroup differences were not significant (HR, 1.29; 95% CI, 0.97-1.72; P = .09). Post hoc subgroup analysis showed no significant intergroup differences in disease-free survival.Conclusions and RelevanceIn this cohort study, long-term outcomes following MABS were not significantly different from those following CBS in patients with early-stage breast cancer. MABS may be a safe and feasible alternative in this patient population.

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Section: Discussionmentioning

confidence: 99%

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

et al. 2022

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“…Additionally, liver sonography, chest x-ray, and whole-body bone scan were used to exclude the possibility of distant metastasis. The indications of 3D E-NSM (3,14) included early-stage breast cancer (ductal carcinoma in situ (DCIS), stage I, II or IIIA), a tumor size ≤ 5 cm, no apparent multiple lymph node metastases, and no evidence of nipple, skin, or chest wall invasion (3,22,23) . 3D E-NSM was contraindicated in any patients with apparent NAC involvement, in ammatory breast cancer, breast cancer with chest wall or skin invasion, locally advanced breast cancer, breast cancer with extensive axillary lymph node metastasis (stage IIIB or later) (3,22,23) .…”

Section: Indications Of Single-port 3d Videoscope Assisted Endoscopic...mentioning

confidence: 99%

“…In addition, patients with severe comorbidity, such as heart disease, renal failure, liver dysfunction, and poor performance status as assessed by the primary physicians were not suitable as good candidates for 3D EABS (3,22,23) .…”

Section: Indications Of Single-port 3d Videoscope Assisted Endoscopic...mentioning

confidence: 99%

“…Furthermore, oncologic safety was evaluated through the incidence of locoregional & distant recurrence and breast cancer-speci c mortality. Locoregional recurrence was de ned as cancer reappearance at the operative site (22) , and distant recurrence was de ned as any recurrence in distal organs (22) . Incidence of recurrence and mortality due to breast cancer was ascertained at the most recent follow-up, which ended in December, 2022.…”

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Single-port three-dimensional (3D) videoscope assisted endoscopic breast surgery-Preliminary results and patient-reported satisfaction in 156 breast cancer and gynecomastia cases

Chia,

Sae-lim,

Lai

et al. 2023

Preprint

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Background Minimal-accessed (robotic and endoscopic) breast cancer surgery increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional (3D) videoscope assisted endoscopic breast surgery (EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. Methods Patients undergone single-port 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. Results During the study period, 156 patients underwent 180 procedures of single port 3D EABS. 166 (92.2%) procedures were 3D endoscopic-assisted nipple-sparing mastectomy (3D E-NSM; 132 therapeutic procedures for breast cancer, 14 prophylactic contralateral mastectomies, 20 procedures for gynecomastia). 14 (7.8%) procedures of 3D endoscopic-assisted breast conserving surgery (3D E-BCS) were performed (12 3D E-BCS, 2 3D E-BCS with 3D videoscope assisted partial breast reconstruction, which was 1 case with latissimus dorsi flap and 1 case with omental flap). Mean operative time was 244 ± 110 minutes in 3D E-NSM and 260 ± 142 minutes in 3D E-BCS. Mean intra-operative blood loss was 50.2 ± 46.5 ml in 3D E-NSM and 32.8 ± 17.5ml in 3D E-BCS. Subnipple biopsy showed positive malignancy in 7 (5.4%) 3D E-NSM patients. None of the 3D E-BCS patients found margin involvement, however, those reported in 3 (2.6%) 3D E-NSM patients. Complications were found in 32 (22%) patients; 7 (4.8%) transient nipple-areolar complex (NAC) ischemia, 7 (4.8%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow up time of 27 months, there were 6 (4.7%) patients with locoregional recurrence, 7 (5.4%) distant metastasis, and 1 (0.7%) mortality. 89.3% (67/75) of patients answering the cosmetic-evaluated questionnaire reported good and excellent satisfaction. Conclusions Single-port 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.

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“…At the end of the 20th century, the theory of minimally invasive surgery gradually matured and endoscopic surgery developed rapidly 10 . Minimally invasive surgery, represented by endoscopic technology, has the advantages of accuracy and small wound 11 . The maturity of these minimally invasive techniques and the success of clinical practice provide useful theories and techniques for the development of breast surgery.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of breast malignant lesions in patients with ultrasound BI-RADS 3, 4a and 4b undergoing Mammotome minimally invasive surgery

Zhu

Dou

Liu

et al. 2023

Preprint

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Background To sort out the basic data and imaging examination results of the patients who underwent the Mammotome minimally invasive surgery, and explore the high-risk underlying factors related to cancerization, in order to optimize the minimally invasive surgery population, and reduce the malignant rate. Methods A total of 1188 female patients who came to our hospital from November 2016 to August 2021 for the Mammotome minimally invasive surgery were analyzed retrospectively. According to the inclusion criteria, the clinical data of 1158 patients and 2164 lesions were finally obtained. We summarized the benign and malignant lesions of BI-RADS category 3, BI-RADS category 4a and BI-RADS category 4b by conventional ultrasound, and got 1562, 578 and 24 lesions respectively. By analyzing the clinical basic data, imaging features and pathological diagnosis of patients, the differences between benign and malignant lesions of these three types were evaluated. Results The malignant rates of BI-RADS category 3, BI-RADS category 4a and BI-RADS category 4b patients who underwent the Mammotome minimally invasive surgery were 0.6%(9/1562), 6.4%(37/578) and 8.3%(2/24) respectively. According to statistics, the age of patients with BI-RADS category 3 is generally younger than that of patients with category 4a and category 4b. Comparing all the three types of lesions in pairs, we found that there were statistical differences in the presence or absence of blood flow signals and the status of calcified lesions, among which category 4b blood flow signal accounted for the highest proportion. Among the category 3 of lesions, we also found that the age of menarche in patients with malignant lesions is younger compared with benign lesions. In category 4a lesions, the patients with malignant lesions were older and mainly concentrated between 40 and 50 years old, and the maximum diameter of the lesions was larger. Whether it is category 3 or category 4a malignant lesions, mammography shows that the incidence of category 4a and multifocal calcification is higher. Conclusion Combined with the clinical data and imaging examination results, BI-RADS category 3 patients have excellent results in choosing Mammotome minimally invasive surgery. Patients with BI-RADS category 4a should be alert to the following factors, including age between 40 and 50, older menarche age, lesion site in the outer upper quadrant, mammography grade of 4a or above, and presence of calcification. Minimally invasive surgery is not recommended for patients diagnosed as BI-RADS category 4b.

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Oncologic Outcome of Endoscopic Assisted Breast Surgery Compared with Conventional Approach in Breast Cancer: An Analysis of 3426 Primary Operable Breast Cancer Patients from Single Institute with and Without Propensity Score Matching

Cited by 17 publications

References 36 publications

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery

Single-port three-dimensional (3D) videoscope assisted endoscopic breast surgery-Preliminary results and patient-reported satisfaction in 156 breast cancer and gynecomastia cases

Risk factors of breast malignant lesions in patients with ultrasound BI-RADS 3, 4a and 4b undergoing Mammotome minimally invasive surgery

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