by Kuo, Yao-Lung; Chang, Chih-Hao; Chang, Tzu-Yen; Chien,
Hsiung-Fei; Liao, Li-Min; Hung, Chin-Sheng; Lin, Shih-Lung; Chen, Shou-Tung;
Chen, Dar-Ren; Lai, Hung-Wen
Plastic and
Reconstructive Surgery: February 2021
- Volume 147 - Issue 2 - p 267-278
Background:
Endoscopy-assisted total mastectomy has been used for
surgical intervention of breast cancer patients; however, large cohort studies
with long-term follow-up data are lacking.
Methods:
Breast cancer patients who underwent endoscopy-assisted
total mastectomy from May of 2009 to March of 2018 were collected prospectively
from multiple centers. Clinical outcome, impact of different phases, oncologic
results, and patient-reported aesthetic outcomes of endoscopy-assisted total
mastectomy were reported.
Results:
A total of 436 endoscopy-assisted total mastectomy
procedures were performed; 355 (81.4 percent) were nipple-sparing mastectomy,
and 81 (18.6 percent) were skin-sparing mastectomy. Three hundred fourteen
(75.4 percent) of the procedures were associated with immediate breast
reconstruction; 255 were prosthesis based and 59 were associated with
autologous flaps. The positive surgical margin rate for endoscopy-assisted
total mastectomy was 2.1 percent. In morbidity evaluation, there were 19 cases
(5.4 percent) with partial nipple necrosis, two cases (0.6 percent) with total
nipple necrosis, and three cases (0.7 percent) with implant loss. Compared with
the early phase, surgeons operating on patients in the middle or late phase had
significantly decreased operation time and blood loss. With regard to
patient-reported cosmetic outcomes, approximately 94.4 percent were satisfied
with the aesthetic results. Patients who underwent breast reconstruction with
preservation of the nipple had higher satisfaction rates. Over a median
follow-up of 54.1 ± 22.4 months, there were 14 cases of locoregional recurrence
(3.2 percent), three distant metastases (0.7 percent), and one mortality (0.2
percent).
Conclusion:
This multicenter study showed that endoscopy-assisted total
mastectomy is a reliable surgical intervention for early breast cancer, with
high patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
IV.
