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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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgments

The authors thank Ya-Ling Lin, Yun-Ting Chang, Shu-Hsin Pai, Yi-Ru Ke, and Shun-Ing Tsai for assistance with this study.

Funding

This study was funded by the Ministry of Science and Technology of Taiwan, and the number of this funding was: MOST-108-2314-B-371-006-. This study was also sponsored by research funding provided by the Changhua Christian Hospital, and the numbers of the funding were: 106-CCH-IRP-015, 106-CCH-IRP-201, 106-CCH-IRP-202, 107-CCH-HCR-035, and 108-CCH-IRP-122.

Author information

Authors and Affiliations

  1. Endoscopic and Oncoplastic Breast Surgery Center, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan

    Hung-Wen Lai MD, Shou-Tung Chen MD & Chin-Mei Tai BS

  2. Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan

    Hung-Wen Lai MD, Shou-Tung Chen MD, Dar-Ren Chen MD & Shou-Jen Kuo MD

  3. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan

    Hung-Wen Lai MD, Shou-Tung Chen MD, Chin-Mei Tai BS, Dar-Ren Chen MD & Shou-Jen Kuo MD

  4. Kaohsiung Medical University, Kaohsiung, Taiwan

    Hung-Wen Lai MD

  5. Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan

    Hung-Wen Lai MD

  6. School of Medicine, National Yang Ming University, Taipei, Taiwan

    Hung-Wen Lai MD

  7. School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Hung-Wen Lai MD

  8. Division of Breast Surgery, Department of Surgery, Changi General Hospital, Singapore, Singapore

    Chi Wei Mok MBBS, FRCSEd

  9. Division of Plastic and Reconstructive Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

    Shih-Lung Lin MD

  10. Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan

    Hung-Wen Lai MD & Chin-Mei Tai BS

  11. Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan

    Ren-Hung Huang MD

  12. Chang Gung University College of Medicine, Taoyuan City, Taiwan

    Hung-Wen Lai MD

  13. Division of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Hung-Wen Lai MD

  14. Tumor Center, Changhua Christian Hospital, Changhua, Taiwan

    Ying-Jen Lin MS

  15. Singhealth Duke-NUS Breast Center, Singapore, Singapore

    Chi Wei Mok MBBS, FRCSEd

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  1. Hung-Wen Lai MD
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Correspondence to Hung-Wen Lai MD.

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Lai, HW., Chen, ST., Tai, CM. et al. 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. Ann Surg Oncol 27, 2255–2268 (2020). https://doi.org/10.1245/s10434-020-08223-0

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