Robotic Versus Conventional or Endoscopic-assisted Nipple-sparing Mastectomy and Immediate Prosthesis Breast Reconstruction in the Management of Breast Cancer: A Prospectively Designed Multicenter Trial Comparing Clinical Outcomes, Medical Cost, and Patient-reported Outcomes (RCENSM-P)

Hung Wen Lai, Dar Ren Chen, Liang Chih Liu, Shou Tung Chen, Yao Lung Kuo, Shih Lung Lin, Yao Chung Wu, Tsung Chun Huang, Chin Sheng Hung, Ying Jen Lin, Hsin Shun Tseng, Chi Wei Mok, Fiona Tsui Fen Cheng

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Objective: To compare the clinical and patient-reported outcomes of minimal access and conventional nipple-sparing mastectomy (C-NSM). The secondary outcomes investigated included medical costs and oncological safety. Background: Minimal-access NSM has been increasingly applied in the treatment of patients with breast cancer. However, prospective multicenter trials comparing robotic-assisted NSM (R-NSM) versus C-NSM or endoscopic-assisted NSM (E-NSM) are lacking. Methods: A prospectively designed 3-arm multicenter, nonrandomized trial (NCT04037852) was conducted from October 1, 2019 to December 31, 2021, to compare R-NSM with C-NSM or E-NSM. Results: A total of 73 R-NSM, 74 C-NSM, and 84 E-NSM procedures were enrolled. The median wound length and operation time of C-NSM was (9 cm, 175 minutes), (4 cm, and 195 minutes) in R-NSM, and (4 cm and 222 minutes) in E-NSM. Complications were comparable among the groups. Better wound healing was observed in the minimal-access NSM group. The R-NSM procedure was 4000 and 2600 United States Dollars more expensive than C-NSM and E-NSM, respectively. Wound/scar and postoperative acute pain evaluation favored the use of minimal access NSM over C-NSM. Quality of life in terms of chronic breast/chest pain, mobility, and range of motion of the upper extremity showed no significant differences. The preliminary oncologic results showed no differences among the 3 groups. Conclusions: R-NSM or E-NSM is a safe alternative if compared with C-NSM in terms of perioperative morbidities, especially with better wound healing. The advantage of minimal access groups was higher wound-related satisfaction. Higher costs remain one of the major limiting factors in the widespread adoption of R-NSM.

Original languageEnglish
Pages (from-to)138-146
Number of pages9
JournalAnnals of Surgery
Volume279
Issue number1
DOIs
Publication statusPublished - Jan 1 2024

Keywords

  • endoscopic-assisted nipple-sparing mastectomy
  • immediate prosthesis breast reconstruction
  • minimal access breast surgery
  • nipple-sparing mastectomy
  • robotic-assisted nipple-sparing mastectomy

ASJC Scopus subject areas

  • Surgery

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