Minimal Access vs Conventional Nipple-Sparing Mastectomy.

Autor:	Kim JH; Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea., Ryu JM; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea., Bae SJ; Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea., Ko BS; Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Choi JE; Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea., Kim KS; Department of Surgery, Kosin University College of Medicine, Gospel Hospital, Busan, Korea., Cha C; Department of Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea., Choi YJ; Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea., Lee HY; Department of Surgery, Korea University Ansan Hospital, Ansan, Korea., Nam SE; Department of Surgery, Konkuk University School of Medicine, Seoul, Korea., Kim Z; Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea., Kang YJ; Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea., Lee MH; Department of Surgery, Keimyung University School of Medicine, Daegu, Korea., Lee JE; Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea., Park E; Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea., Shin HJ; Department of Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea., Kim MK; Department of Surgery, Chung-Ang University Hospital, Seoul, Korea., Choi HJ; Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea., Kwon SU; Department of Surgery, Konyang University Hospital, Daejeon, Korea., Son NH; Department of Statistics, Keimyung University, Daegu, Korea., Park HS; Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea., Lee J; Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Oct 01; Vol. 159 (10), pp. 1177-1186.
DOI:	10.1001/jamasurg.2024.2977
Abstrakt:	Importance: While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). Objective: To examine the differences in postoperative complications between C-NSM and M-NSM. Design, Setting, Participants: This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. Exposures: M-NSM or C-NSM. Main Outcomes and Measures: Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. Results: There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). Conclusions and Relevance: The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.
Databáze:	MEDLINE
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