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Outcomes of robotic nipple-sparing mastectomy versus conventional nipple-sparing mastectomy in women with breast cancer: a systematic review and meta-analysis

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Abstract

The promising results of the robotic approach for multiple cancer operations has led to interest in the potential of robotic nipple-sparing mastectomy (R-NSM); however, further studies are required to compare the benefits and complications of this approach with those of conventional open nipple-sparing mastectomy (C-NSM). We performed a meta-analysis to compare surgical complications of R-NSM versus C-NSM. We performed a review of literature through June 2022 in PubMed, Scopus, and EMBASE. We included randomized controlled trials (RCTs), cohorts, case–control studies, and case series with > 50 patients comparing the two techniques. Separate meta-analyses were conducted according to study design. From 80 publications, we identified six studies. The sample size ranged from 63 to 311 mastectomies from 63 to 275 patients. The tumor size and disease stage were similar between groups. The positive margin rate was 0–4.6% in the R-NSM arm and 0–2.9% in the C-NSM arm. Four studies reported early recurrence data, which were similar between groups (R-NSM: 0%, C-NSM: 0–8%). The R-NSM group had a lower rate of overall complications compared to the C-NSM group in cohorts/RCTs (RR = 0.68, 95%CI 0.49–0.96). In case–control studies, rate of necrosis was lower with R-NSM. Operative time was significantly longer in the R-NSM group in cohort/RCTs. In early experience with R-NSM, R-NSM had a lower overall complication rate compared to C-NSM in cohorts/RCTs. While these data are promising, our results show variability and heterogeneity limiting definitive conclusions. Additional trials are needed to guide the role of R-NSM and its oncologic outcomes.

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Data Availability

 All data generated or analysed during this study are included in this published article (and its supplementary information files).

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This work was supported by Self-funded.

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Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Gabriel De la Cruz-Ku, Larissa Pamen, David Linshaw & Jennifer LaFemina

  2. Universidad Científica del Sur, Lima, Perú

    Gabriel De la Cruz-Ku & Diego Chambergo-Michilot

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Armando Perez & Judy C. Boughey

  4. Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

    Bryan Valcarcel

  5. Division of Surgical Oncology, Division of Plastic Surgery, Tufts Medical Center/Tufts School of Medicine, Boston, MA, USA

    Abhishek Chatterjee

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  1. Gabriel De la Cruz-Ku
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GDC and DCM. The first draft of the manuscript was written by, GDC, DCM, AP, BV, LP, DL, AC, JLF, JB, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gabriel De la Cruz-Ku.

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Conflict of interests

Dr. Chatterjee is a consultant for 3M and Royal. None of the remaining authors has any commercial interest in the subject of this study that may be perceived as a potential conflict of interest. No industry or financial/material support was given specifically for this study. Dr. Boughey - funding from Lilly and SymBioSis for unrelated research, on DSMB for Cairns Surgical for clinical trial, investigator on R-NSM Intuitive trial. The other authors declare no pertinent conflicts of interest.

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De la Cruz-Ku, G., Chambergo-Michilot, D., Perez, A. et al. Outcomes of robotic nipple-sparing mastectomy versus conventional nipple-sparing mastectomy in women with breast cancer: a systematic review and meta-analysis. J Robotic Surg 17, 1493–1509 (2023). https://doi.org/10.1007/s11701-023-01547-5

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