Minimal access surgery safe and feasible alternative to conventional surgery for breast cancer: JAMA

Minimal access breast surgery (MABS) has been used in breast cancer management. However, long-term predictive data associated with MABS vs conventional breast surgery (CBS) are lacking.

A study investigated long-term therapeutic outcomes associated with MABS vs CBS for breast cancer management.

In this single-centre retrospective cohort study, 9184 individuals were assessed for inclusion. After exclusions, 2412 adult female individuals were included who were diagnosed with stage 0 to III breast cancer, underwent unilateral breast surgery between January 2004 and December 2017, and had no distant metastasis or history of severe underlying disease. Propensity score matching was performed to minimize selection bias. Data were analyzed from January 1, 2004, to December 31, 2019. Data on demographic and tumour characteristics and long-term outcomes were collected and analyzed.

Results:

• This study included 2412 patients
• Of these, 603 patients underwent MABS (endoscopic, endoscopy-assisted, or robot-assisted procedures in 289, 302, and 12 patients, respectively) and 1809 patients underwent CBS.
• The median follow-up time was 84 months
• Intergroup differences were not significant for the following parameters: 10-year local recurrence-free survival, regional recurrence-free survival, and distant metastasis-free survival
• The 5-, 10-, and 15-year disease-free survival rates in the MABS group were 85.9%, 72.6%, and 69.1%, respectively.
• The corresponding rates in the CBS group were 85.0%, 76.6%, and 70.7%.
• The intergroup differences were not significant
• The MABS group's 5-, 10-, and 15-year overall survival rates were 92.0%, 83.7%, and 83.0%, respectively.
• The corresponding rates in the CBS group were 93.6%, 88.7%, and 81.0%. The intergroup differences were not significant
• Post hoc subgroup analysis showed no significant intergroup differences in disease-free survival.

In this cohort study, long-term outcomes following MABS were not significantly different from those following CBS in patients with early-stage breast cancer. MABS may be a safe and feasible alternative in this patient population.

Reference:

Wan A, Liang Y, Chen L, et al. Association of Long-term Oncologic Prognosis With Minimal Access Breast Surgery vs Conventional Breast Surgery. JAMA Surg. Published online October 05, 2022. doi:10.1001/jamasurg.2022.4711