Technical Feasibility and Cosmetic Advantage of Hybrid Endoscopy-Assisted Breast-Conserving Surgery for Breast Cancer Patients

Abstract

Background:

We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid EBCS and compare the cosmetic outcomes between hybrid EBCS and conventional breast-conserving surgery (CBCS).

Patients and Methods:

We reviewed medical records of patients who had undergone hybrid EBCS (n=73) or CBCS (n=90) between May 2005 and April 2011 and had been followed up in our department until March 2012. The clinical outcomes and cosmetic outcomes of these two groups were compared. The safety of hybrid EBCS was also analyzed by confirming its complications and pathological surgical margin.

Results:

In the hybrid EBCS group, operation time was longer by 30–50 minutes. Blood loss was not significantly different between the two groups. The surgical margin of hybrid EBCS was as follows: 1 patient (1.4%) had a positive margin, 4 patients (5.5%) had a margin of <2 mm, in 9 patients (12.3%) the margin was ≥2 mm and <5 mm, and in 59 patients (80.8%) it was ≥5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid EBCS patients. To date, no local recurrence has been observed in hybrid EBCS patients (postoperative observation period, 18.1±5.6 months). Compared with the CBCS group, the hybrid EBCS group had better cosmetic results, especially with a less noticeable operative scar (P<.01).

Conclusions:

Hybrid EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.

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References

Fisher

, Anderson

, Bryant

et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002; 347:1233–1241.

Veronesi

, Cascinelli

, Mariani

et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 2002; 347:1227–1232.

Sonoo

, Noguchi

. Academic Committee of the Japanese Breast Cancer Society. 14. Results of questionnaire survey on breast cancer surgery in Japan 2004–2006. Breast Cancer, 2008; 15:3–4.

Asgeirsson

, Rasheed

, McCulley

et al. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol, 2005; 31:817–823.

Fukuma

. Endoscopic breast surgery for breast cancer [article in Japanese with English abstract] Nippon Geka Gakkaiabstract Zasshi, 2006; 7:64–68.

Yamagata

, Iwai

. Endoscopic treatment for breast cancer [article in Japanese with English abstract] J Jpn Soc Endosc Surg, 1997; 2:272–277.

Tamaki

, Sakita

, Miyoshi

et al. Transareolar endoscopy-assisted partial mastectomy. Surg Laparosc Endosc, 2001; 11:356–362.

Nakajima

, Fujiwara

, Mizuta

et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue: Clinical outcomes. Ann Surg Oncol, 2009; 249:91–96.

Park

, Lee

et al. The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer, 2011; 14:52–57.

10.

Leff

, Vashisht

, Yongue

et al.

Endoscopic breast surgery: Where are we now and what might the future hold for video-assisted breast surgery?

Breast Cancer Res Treat, 2011; 125:607–625.

11.

Sawai

, Nakajima

, Ichihara

, Yano

, Watanabe

, Kitamura

et al. Cosmetic assessment of the breast after surgery. The 12th Annual Meeting of the Japan Breast Cancer Society, 2004; 12:107–108.

12.

Kijima

, Yoshinaka

, Funasako

et al. Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions. Surg Today, 2011; 41:477–489.

13.

Winchester

, Cox

. Standards for breast-conservation treatment. CA Cancer J Clin, 1992; 42:134–162.

14.

Sakamoto

, Fukuma

, Higa

et al. Early results of an endoscopic nipple-sparing mastectomy for breast cancer. Ann Surg Oncol, 2009; 16:3406–3413.

15.

Carlson

. Total mastectomy under local anesthesia: The tumescent technique. Breast J, 2005; 11:100–102.

16.

Seth

, Hirsch

, Fine

et al. Additive risk of tumescent technique in patients undergoing mastectomy with immediate reconstruction. Ann Surg Oncol, 2011; 18:3041–3046.

17.

Noguchi

, Inokuchi

, Ohno

et al. Oncological and cosmetic outcome in breast cancer patients undergoing “moving window” operation. Breast Cancer Res Treat, 2011; 129:849–856.

18.

Ozaki

, Fukuma

, Sakamoto

et al.

Clinical experience of endoscopic vein retractor, FREIBURG model for breast cancer in endoscopic surgery [article in Japanese with English abstract]

J Jpn Soc Endosc Surg, 2010; 2:137–145.

19.

Rahusen

, Bremers

, Fabry

et al. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: A randomized clinical trial. Ann Surg Oncol, 2002; 9:994–998.

20.

Snider

HCJ

, Morrison

. Intraoperative ultrasound localization of nonpalpable breast lesions. Ann Surg Oncol, 1999; 6:308–314.

21.

Moore

, Whitney

, Cerilli

et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg, 2001; 233:761–768.

22.

Davis

, Hsu

, Bouton

et al. Intraoperative ultrasound can decrease the re-excision lumpectomy rate in patients with palpable breast cancers. Am Surg, 2011; 77:720–725.

23.

Fisher

, Mushawah

, Cyr

et al. Ultrasound-guided lumpectomy for palpable breast cancers. Ann Surg Oncol, 2011; 18:3198–3120.

24.

Waljee

, Hu

, Ubel

et al. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol, 2008; 26:3331–3337.