Division of Breast Surgery, European Institute of Oncology IRCCS, Milan, Italy.
Data Management, European Institute of Oncology IRCCS, Milan, Italy.
Ann Surg Oncol. 2019 Oct;26(10):3046-3051. doi: 10.1245/s10434-019-07590-7. Epub 2019 Jul 24.
Robotic nipple-sparing mastectomy (RNSM) may allow for more precise anatomic dissection and improved cosmetic outcomes over conventional open nipple-sparing mastectomy; however, data regarding the feasibility and safety of the procedure are limited.
The aim of this study was to present and discuss perioperative surgical outcomes and early oncologic follow-up data on consecutive patients undergoing RNSM from June 2014 to January 2019.
Patients underwent RNSM and immediate robotic breast reconstruction through an axillary incision at a single institution. Perioperative data, complications at 3 months postoperatively, pathological data, and adjuvant therapies were recorded. Local recurrence-free, disease-free, and overall survival were analyzed.
Overall, 73 women underwent 94 RNSM procedures. Indications were invasive breast cancer in 39 patients, ductal carcinoma in situ in 17 patients, and BRCA mutation in 17 patients. Mean surgery time was 3 h and 32 min. One-step reconstruction with implant occurred in 89.4% of procedures. The rate of complications requiring reoperation was 4.3%, and the rate of flap or nipple necrosis was 1.1%. Median follow-up was 19 months (range 3.1-44.8). No local recurrences occurred. Overall survival at 12, 24, or 60 months was 98% (95% confidence interval 86-100%).
We observed a low complication rate in 94 consecutive RNSM procedures, demonstrating the procedure is technically feasible and safe. We found no early local failures at 19 months follow-up. Long-term follow-up is needed to confirm oncologic safety. Future clinical trials to study the advantages and disadvantages of RNSM are warranted.
与传统的开放性保留乳头乳房切除术相比，机器人保留乳头乳房切除术（RNSM）可能允许更精确的解剖分离并改善美容效果；然而，关于该手术的可行性和安全性的数据有限。
本研究旨在介绍并讨论 2014 年 6 月至 2019 年 1 月期间连续接受 RNSM 的患者的围手术期外科手术结果和早期肿瘤随访数据。
患者在一家机构接受 RNSM 和通过腋窝切口的即刻机器人乳房重建。记录围手术期数据、术后 3 个月的并发症、病理数据和辅助治疗。分析局部无复发生存、无病生存和总生存。
共有 73 名女性接受了 94 例 RNSM 手术。39 例患者为浸润性乳腺癌，17 例患者为导管原位癌，17 例患者为 BRCA 突变。平均手术时间为 3 小时 32 分钟。89.4%的手术采用一步法植入物重建。需要再次手术的并发症发生率为 4.3%，皮瓣或乳头坏死的发生率为 1.1%。中位随访时间为 19 个月（范围 3.1-44.8）。无局部复发。12、24 或 60 个月的总生存率为 98%（95%置信区间 86-100%）。
我们观察到 94 例连续 RNSM 手术的并发症发生率较低，表明该手术技术上可行且安全。我们在 19 个月的随访中未发现早期局部失败。需要长期随访以确认肿瘤学安全性。未来有必要开展临床试验以研究 RNSM 的优缺点。
