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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2020

01-07-2020 | Mastectomy | Breast Oncology

Robotic- Versus Endoscopic-Assisted Nipple-Sparing Mastectomy with Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Case–Control Comparison Study with Analysis of Clinical Outcomes, Learning Curve, Patient-Reported Aesthetic Results, and Medical Cost

Authors: Hung-Wen Lai, MD, Shou-Tung Chen, MD, Chin-Mei Tai, BS, Shih-Lung Lin, MD, Ying-Jen Lin, MS, Ren-Hung Huang, MD, Chi Wei Mok, MBBS, FRCSEd, Dar-Ren Chen, MD, Shou-Jen Kuo, MD

Published in: Annals of Surgical Oncology | Issue 7/2020

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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.
Appendix
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Metadata
Title
Robotic- Versus Endoscopic-Assisted Nipple-Sparing Mastectomy with Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Case–Control Comparison Study with Analysis of Clinical Outcomes, Learning Curve, Patient-Reported Aesthetic Results, and Medical Cost
Authors
Hung-Wen Lai, MD
Shou-Tung Chen, MD
Chin-Mei Tai, BS
Shih-Lung Lin, MD
Ying-Jen Lin, MS
Ren-Hung Huang, MD
Chi Wei Mok, MBBS, FRCSEd
Dar-Ren Chen, MD
Shou-Jen Kuo, MD
Publication date
01-07-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08223-0

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