Comparative study of axillary single-incision endoscopic breast-conserving surgery and conventional open breast-conserving surgery for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Tianyuan ^1,2 , XIE Yanyan ^1,2 , WU Hao ^1,2 , ZHU Zhongjian ^1,2 ,  DU Zhenggui ^1,2

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

Corresponding?author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

breast cancer; axillary single-incision endocsopic breast-conserving surgery; conventional open breast-conserving surgery; aesthetic outcome; oncological safety

DOI：

10.7507/1007-9424.202503013

Video：

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Objective To compare the differences in surgical efficiency, surgical safety, aesthetic outcomes, and oncological safety between axillary single-incision endocsopic breast-conserving surgery (ASIEBS) and conventional open breast-conserving surgery (COBS), and to evaluate the clinical value of ASILBCS based on the “HUAXI hole 3” technique. Methods A retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breast-conserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach. Both groups received standardized surgical treatment and postoperative follow-up. The observation indicators included baseline characteristics, intraoperative data, postoperative complications, aesthetic outcome (by Ueda score and Harris score evaluation), and oncological safety (local recurrence and distant metastasis). Results A total of 67 patients were enrolled, with 41 in the ASIEBS group and 26 in the COBS group. There was no statistically significant differences in the comparison of other baseline data between the two groups (P>0.05), except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2 (P＜0.05). The ASIEBS group showed superior aesthetic outcomes compared to the COBS group (Ueda score: P=0.013; Harris score: P=0.047). However, the ASIEBS group had higher median total hospitalization costs (12 779.00 yuan vs. 12 354.50 yuan, Z=–2.16, P=0.03). The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group (Z=–2.36, P=0.02). During follow-up, only one patient with local recurrence occurred in the ASIEBS group, and no distant metastasis or death event was observed in both groups. Conclusion The ASIEBS based on the “HUAXI hole 3” technique is comparable to COBS in terms of surgical efficiency, surgical safety, and oncological safety, while offering superior aesthetic outcomes.

Citation： LI Tianyuan, XIE Yanyan, WU Hao, ZHU Zhongjian, DU Zhenggui. Comparative study of axillary single-incision endoscopic breast-conserving surgery and conventional open breast-conserving surgery for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 282-287. doi: 10.7507/1007-9424.202503013 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	鄔昊, 呂青. 全球及中國乳腺癌的流行病學趨勢及防控啟示: 2018–2022年《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(7): 796-802.
3.	姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
4.	Chen JJ, Huang NS, Xue JY, et al. Current status of breast reconstruction in southern China: A 15 year, single institutional experience of 20 551 breast cancer patients. Medicine (Baltimore), 2015, 94(34): e1399. doi: 10.1097/MD.0000000000001399.
5.	王佳妮, 歐開萍, 劉嘉琦, 等. 乳腺癌多學科綜合診療模式的能力建設及發展趨勢. 中國普通外科雜志, 2023, 32(5): 656-664.
6.	劉瀛. 保乳術與改良根治術治療早期乳腺癌的臨床療效分析. 中國普通外科雜志, 2014, 23(5): 709-711.
7.	沈裕厚, 岳愛民, 尹宏達, 等. 腫瘤整形技術在乳腺癌保乳手術中的臨床應用. 中國普通外科雜志, 2022, 31(5): 577-586.
8.	De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
9.	王曉文, 劉超, 歐江華. 單孔腔鏡保乳術與開放保乳術治療早期乳腺癌的療效及安全性比較. 中華普外科手術學雜志(電子版), 2021, 15(5): 558-561.
10.	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.
11.	Kimball CC, Nichols CI, Vose JG, et al. Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011–2016. Ann Surg Oncol, 2018, 25(13): 3867-3873.
12.	Owaki T, Yoshinaka H, Ehi K, et al. Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision. Breast, 2005, 14(1): 57-60.
13.	駱成玉. 腔鏡技術在乳腺癌治療應用及評價. 中國實用外科雜志, 2015, 35(7): 721-723.
14.	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.
15.	Gui Y, Chen Q, Li S, et al. Safety and feasibility of minimally invasive (laparoscopic/robotic-assisted) nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: A single-center retrospective study. Ann Surg Oncol, 2022 Feb 16. doi: 10.1245/s10434-022-11420-8.
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.	Lu S, Yang J, Wei T, et al. Single-incision endoscope-assisted breast-conserving surgery and sentinel lymph node biopsy: prospective SINA-BCS cohort study. Br J Surg, 2023, 110(9): 1076-1079.
18.	Wang ZH, Ng HI, Teng CS, et al. Outcomes of single-port gasless laparoscopic breast-conserving surgery for breast cancer: An observational study. Breast J, 2019, 25(3): 461-464.
19.	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.
20.	張晴, 謝妍妍, 梁法清, 等. 腔鏡和機器人手術在乳腺疾病治療中的前世今生. 中國修復重建外科雜志, 2024, 38(7): 769-775.
21.	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.
22.	Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
23.	Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
24.	萬安弟, 周于欽, 張聰, 等. 腔鏡與開放保乳手術治療早期乳腺癌的近期療效比較. 中國普通外科雜志, 2023, 32(11): 1743-1751.
25.	劉義粉, 尹長恒. 開放保乳術與單孔法腔鏡保乳術治療早期乳腺癌的療效及對患者生存質量的影響. 實用醫學雜志, 2019, 35(17): 2770-2774.
26.	牛增志, 張玉潔, 楊明軍, 等. 單孔法腔鏡保乳術和開放保乳術治療早期乳腺癌的療效及患者對乳房外觀的影響. 癌癥進展, 2024, 22(12): 1363-1366.
27.	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.
28.	杜正貴, 李田園, 梁法清, 等. 腔鏡乳腺癌手術應用現狀及展望. 中國實用外科雜志, 2024, 44(11): 1206-1210.
29.	Ozaki S, Ohara M, Shigematsu H, et al. Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A, 2013, 23(2): 91-99.
30.	Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol, 2010, 17(5): 1375-1391.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 鄔昊, 呂青. 全球及中國乳腺癌的流行病學趨勢及防控啟示: 2018–2022年《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(7): 796-802.
3. 姚一菲, 孫可欣, 鄭榮壽. 《2022全球癌癥統計報告》解讀: 中國與全球對比. 中國普外基礎與臨床雜志, 2024, 31(7): 769-780.
4. Chen JJ, Huang NS, Xue JY, et al. Current status of breast reconstruction in southern China: A 15 year, single institutional experience of 20 551 breast cancer patients. Medicine (Baltimore), 2015, 94(34): e1399. doi: 10.1097/MD.0000000000001399.
5. 王佳妮, 歐開萍, 劉嘉琦, 等. 乳腺癌多學科綜合診療模式的能力建設及發展趨勢. 中國普通外科雜志, 2023, 32(5): 656-664.
6. 劉瀛. 保乳術與改良根治術治療早期乳腺癌的臨床療效分析. 中國普通外科雜志, 2014, 23(5): 709-711.
7. 沈裕厚, 岳愛民, 尹宏達, 等. 腫瘤整形技術在乳腺癌保乳手術中的臨床應用. 中國普通外科雜志, 2022, 31(5): 577-586.
8. De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
9. 王曉文, 劉超, 歐江華. 單孔腔鏡保乳術與開放保乳術治療早期乳腺癌的療效及安全性比較. 中華普外科手術學雜志(電子版), 2021, 15(5): 558-561.
10. 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.
11. Kimball CC, Nichols CI, Vose JG, et al. Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011–2016. Ann Surg Oncol, 2018, 25(13): 3867-3873.
12. Owaki T, Yoshinaka H, Ehi K, et al. Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision. Breast, 2005, 14(1): 57-60.
13. 駱成玉. 腔鏡技術在乳腺癌治療應用及評價. 中國實用外科雜志, 2015, 35(7): 721-723.
14. 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.
15. Gui Y, Chen Q, Li S, et al. Safety and feasibility of minimally invasive (laparoscopic/robotic-assisted) nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: A single-center retrospective study. Ann Surg Oncol, 2022 Feb 16. doi: 10.1245/s10434-022-11420-8.
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. Lu S, Yang J, Wei T, et al. Single-incision endoscope-assisted breast-conserving surgery and sentinel lymph node biopsy: prospective SINA-BCS cohort study. Br J Surg, 2023, 110(9): 1076-1079.
18. Wang ZH, Ng HI, Teng CS, et al. Outcomes of single-port gasless laparoscopic breast-conserving surgery for breast cancer: An observational study. Breast J, 2019, 25(3): 461-464.
19. 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.
20. 張晴, 謝妍妍, 梁法清, 等. 腔鏡和機器人手術在乳腺疾病治療中的前世今生. 中國修復重建外科雜志, 2024, 38(7): 769-775.
21. 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.
22. Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
23. Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
24. 萬安弟, 周于欽, 張聰, 等. 腔鏡與開放保乳手術治療早期乳腺癌的近期療效比較. 中國普通外科雜志, 2023, 32(11): 1743-1751.
25. 劉義粉, 尹長恒. 開放保乳術與單孔法腔鏡保乳術治療早期乳腺癌的療效及對患者生存質量的影響. 實用醫學雜志, 2019, 35(17): 2770-2774.
26. 牛增志, 張玉潔, 楊明軍, 等. 單孔法腔鏡保乳術和開放保乳術治療早期乳腺癌的療效及患者對乳房外觀的影響. 癌癥進展, 2024, 22(12): 1363-1366.
27. 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.
28. 杜正貴, 李田園, 梁法清, 等. 腔鏡乳腺癌手術應用現狀及展望. 中國實用外科雜志, 2024, 44(11): 1206-1210.
29. Ozaki S, Ohara M, Shigematsu H, et al. Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A, 2013, 23(2): 91-99.
30. Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol, 2010, 17(5): 1375-1391.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative study of axillary single-incision endoscopic breast-conserving surgery and conventional open breast-conserving surgery for breast cancer

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