Abstract
BACKGROUND: Breast cancer is the most common cancer worldwide, with remarkable advances in early diagnosis, systemic treatments, and surgical techniques. Robotic nipple-sparing mastectomy has been trialled; however, the complication rates, surgical outcomes, and oncological safety of this approach remain obscure.
METHODS: A systematic search of the literature was conducted from conception until September 2022. Studies examining complications and operative variables where robotic nipple-sparing mastectomy was compared with conventional nipple-sparing mastectomy were included. Primary study outcomes were complications (Clavien-Dindo grade III complications, skin or nipple necrosis, seroma, haematoma, infection, implant loss, and wound dehiscence) and oncological safety (recurrence and positive margins). The secondary outcomes included operative variables, length of stay, cost-effectiveness, learning curve, and aesthetic outcome.
RESULTS: A total of seven studies of overall fair quality, involving 1674 patients, were included in the systematic review and meta-analysis. Grade 3 complications were reduced in robotic nipple-sparing mastectomy without statistical significance (OR 0.60 (95 per cent c.i. 0.35 to 1.05)). Nipple necrosis was significantly reduced in robotic nipple-sparing mastectomy (OR 0.54 (95 per cent c.i. 0.30 to 0.96); P = 0.03; I2 = 15 per cent). Operating time (mean difference +58.81 min (95 per cent c.i. +28.19 to +89.44 min); P = 0.0002) and length of stay (mean difference +1.23 days (95 per cent c.i. +0.64 to +1.81 days); P < 0.0001) were significantly increased in robotic nipple-sparing mastectomy, whereas the opposite was true for blood loss (mean difference -53.18 ml (95 per cent c.i. -71.78 to -34.58 ml); P < 0.0001).
CONCLUSION: Whilst still in its infancy, robotic breast surgery may become a viable option in breast surgery. Nonetheless, the oncological safety of this approach requires robust assessment.
| Original language | English |
|---|---|
| Article number | znad336 |
| Number of pages | 9 |
| Journal | British Journal of Surgery |
| Volume | 111 |
| Issue number | 1 |
| Early online date | 27 Oct 2023 |
| DOIs | |
| Publication status | Published - Jan 2024 |
| Event | ABS Conference 2023 - Belfast, United Kingdom Duration: 15 May 2023 → 16 May 2023 |
Bibliographical note
The authors acknowledge NHSG Library and Knowledge Services.Data Availability Statement
All crude data available upon request.Keywords
- hemorrhage
- cancer
- cost effectiveness
- hematoma
- postoperative complications
- length of stay
- necrosis
- nipples
- surgical procedures
- operative
- breast cancer
- wound seroma
- patient self-report
- nipple-sparing mastectomy
- surgical outcome
- implants
- Humans
- Mastectomy/methods
- Female
- Retrospective Studies
- Robotic Surgical Procedures/adverse effects
- Postoperative Complications/etiology
- Treatment Outcome
- Necrosis/complications
- Nipples/surgery
- Breast Neoplasms/surgery
- Mammaplasty/methods
Access to Document
- Nessa_Etal_BJS_Postoperative_Complications_And_VOR
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.