Oncological safety in endoscopic and robotic breast-conserving surgery and breast reconstruction surgery for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Yihang ¹ , CAO Xiaoman ^2,3 , LI Tianyuan ^2,3 , DAI Hui ^2,3 , ZHANG Qing ^2,3 , CHUNG Kawu ^2,3 ,  DU Zhenggui ^2,3

1. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Breast Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

breast cancer; endoscopic surgery; robotic surgery; oncological safety

DOI：

10.7507/1007-9424.202502085

Video：

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Abstract Full text Figures/Tables Video References Cited by

Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.

Citation： ZHANG Yihang, CAO Xiaoman, LI Tianyuan, DAI Hui, ZHANG Qing, CHUNG Kawu, DU Zhenggui. Oncological safety in endoscopic and robotic breast-conserving surgery and breast reconstruction surgery for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 265-271. doi: 10.7507/1007-9424.202502085 Copy

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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 姜軍, 楊新華, 范林軍, 等. 腔鏡手術在乳腺疾病外科治療中的應用. 中華醫學雜志, 2005, 85(3): 181-183.
3. 屈翔, 王子函, 王勁夫, 等. 腔鏡手術在乳腺癌外科的應用與前景. 中國實用外科雜志, 2018, 38(11): 1245-1248.
4. Kerbl DC, McDougall EM, Clayman RV, et al. A history and evolution of laparoscopic nephrectomy: perspectives from the past and future directions in the surgical management of renal tumors. J Urol, 2011, 185(3): 1150-1154.
5. 吳淞, 章佳新. 乳腺腔鏡手術操作空間建立的進展分析. 中國繼續醫學教育, 2020, 12(12): 114-116.
6. 劉順順, 李平, 李忠, 等. 腔鏡腋窩淋巴結清掃在早期乳腺癌保乳手術中的應用. 中國普通外科雜志, 2012, 21(5): 516-520.
7. 謝妍妍, 呂青, 杜正貴. 乳腺腔鏡和機器人手術的現狀及未來之路—華西醫院經驗分享. 外科理論與實踐, 2022, 27(5): 396-402.
8. Yamashita K, Shimizu K. Endoscopic video-assisted breast surgery: procedures and short-term results. J Nippon Med Sch, 2006, 73(4): 193-202.
9. Yamashita K, Shimizu K. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast. Chin Med J (Engl), 2008, 121(20): 1960-1964.
10. Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue. Ann Surg, 2009, 249(1): 91-96.
11. Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue: clinical outcomes. Ann Surg Oncol, 2009, 16(7): 1982-1989.
12. Nakajima H, Fujiwara I, Mizuta N, et al. Clinical outcomes of video-assisted skin-sparing partial mastectomy for breast cancer and immediate reconstruction with latissimus dorsi muscle flap as breast-conserving therapy. World J Surg, 2010, 34(9): 2197-2203.
13. Park HS, Lee JS, Lee JS, et al. The feasibility of endoscopy-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer, 2011, 14(1): 52-57.
14. Saimura M, Mitsuyama S, Anan K, et al. Endoscopy-assisted breast-conserving surgery for early breast cancer. Asian J Endosc Surg, 2013, 6(3): 203-208.
15. Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg, 2014, 3(2): 94-108.
16. Takahashi H, Fujii T, Nakagawa S, et al. Usefulness of endoscopic breast-conserving surgery for breast cancer. Surg Today, 2014, 44(11): 2037-2044.
17. Lai HW, Mok CW, Chang YT, et al. Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol, 2020, 46(8): 1446-1455.
18. Lai HW, Chen ST, Lin YJ, et al. Minimal access (endoscopic and robotic) breast surgery in the surgical treatment of early breast cancer-trend and clinical outcome from a single-surgeon experience over 10 years. Front Oncol, 2021, 11: 739144. doi: 10.3389/fonc.2021.739144.
19. 徐威, 王子函, 高國璇, 等. 單孔充氣法腔鏡乳腺癌保乳手術66例療效分析. 中國實用外科雜志, 2020, 40(10): 1155-1158.
20. Xie F, Wang ZH, Wu SS, et al. Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer. World J Surg Oncol, 2022, 20(1): 335. doi: 10.1186/s12957-022-02798-6.
21. 邱夢雪, 楊煥佐, 周嬌, 等. 基于華西三號孔的腋窩入路腔鏡乳腺良性腫瘤切除及惡性腫瘤保乳術技巧與療效分析. 中國胸心血管外科臨床雜志, 2023, 30(3): 350-356.
22. Yu HY, Friedlander DF, Patel S, et al. The current status of robotic oncologic surgery. CA Cancer J Clin, 2013, 63(1): 45-56.
23. Morrow M. Robotic nipple-sparing mastectomy-ready for prime time?. JAMA Surg, 2024, 159(3): 276. doi: 10.1001/jamasurg.2023.7007.
24. 中國抗癌協會乳腺癌專業委員會, 中國醫師協會外科醫師分會乳腺外科醫師委員會, 上海市抗癌協會乳腺癌專業委員會. 乳腺腫瘤整形與乳房重建專家共識(2022年版). 中國癌癥雜志, 2022, 32(9): 836-924.
25. Franceschini G, Visconti G, Garganese G, et al. Nipple-sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique. Breast J, 2020, 26(2): 206-210.
26. 關山, 王宇, 張開通, 等. 應用皮膚懸吊系統腔鏡下保留乳頭乳暈乳腺切除即刻乳房重建. 中華外科雜志, 2017, 55(2): 126-129.
27. Langer I, Kocher T, Guller U, et al. Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients. Breast Cancer Res Treat, 2005, 90(1): 85-91.
28. Salvat J, Knopf JF, Ayoubi JM, et al. Endoscopic exploration and lymph node sampling of the axilla. Preliminary findings of a randomized pilot study comparing clinical and anatomo-pathologic results of endoscopic axillary lymph node sampling with traditional surgical treatment. Eur J Obstet Gynecol Reprod Biol, 1996, 70(2): 165-173.
29. Malur S, Bechler J, Schneider A. Endoscopic axillary lymphadenectomy without prior liposuction in 100 patients with invasive breast cancer. Surg Laparosc Endosc Percutan Tech, 2001, 11(1): 38-42.
30. 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, 2022, 157(12): e224711. doi: 10.1001/jamasurg.2022.4711.
31. 高國璇, 王紅衛, 丁國乾, 等. 單孔充氣法腔鏡胸肌前一期假體植入乳房重建術臨床分析. 國際外科學雜志, 2022, 49(3): 168-174, C2.
32. Lai HW, Lin SL, Chen ST, et al. Single-axillary-incision endoscopic-assisted hybrid technique for nipple-sparing mastectomy: Technique, preliminary results, and patient-reported cosmetic outcome from preliminary 50 procedures. Ann Surg Oncol, 2018, 25(5): 1340-1349.
33. Lee HY, Chang YW, Yu DY, et al. Comparison of single incision endoscopic nipple-sparing mastectomy and conventional nipple-sparing mastectomy for breast cancer based on initial experience. J Breast Cancer, 2021, 24(2): 196-205.
34. Luo C, Guo W, Yang J, et al. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc, 2012, 87(12): 1153-1161.
35. 郭美琴. 吸脂法腔鏡腋窩淋巴結清掃術淋巴結組織學改變的臨床對照研究. 2007中國外科周暨第16屆亞洲外科年會論文集, 2007: 127-128.
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