Comparative analysis of oncological and surgical outcomes of robotic versus conventional mastectomy for breast cancer

Abstract

Objective: This study aimed to compare the surgical and oncological outcomes of robotic mastectomy (RM) and conventional mastectomy (CM) for breast cancer.

Methods: Our institutional registry of women with breast cancer who received RM between 2018 and 2023 and CM between 2016 and 2023 were reviewed. Propensity score matching of clinicopathological variables was used to match 123 RM patients with 123 CM patients. Surgical outcomes, reconstruction type, margin status, complications, recurrence-free survival (RFS), and overall survival (OS) were compared between the 2 groups. Complications with increasing RM experience were also examined.

Results: More autologous flap reconstructions were used in RM (67 % vs. 39 %, p < 0.001), but more implant reconstructions were used in CM (61 % vs. 33 %, p < 0.001). The complication rate, especially breast skin necrosis, was lower in the RM group (10 % vs. 26 %, p = 0.002). Nipple-areolar complex necrosis in nipple-sparing mastectomy was similar between the groups (33 % vs. 27 %, p = 0.45). At a median follow-up of 30 months, RFS was comparable between the 2 groups, as was OS (median follow-up 36 months). More RM experience was associated with shorter operation time and lower surgical complication and margin positive rates.

Conclusion: The oncological outcomes of RM and CM are similar at a follow-up of about 3 years. RM is associated with a significantly lower rate of breast skin necrosis, and the advantage of RM exists with different types of breast reconstruction. Increasing RM experience leads to improved overall results.

Keywords: Breast cancer; Mastectomy; Minimally invasive breast surgery; Nipple-sparing mastectomy; Robot-assisted mastectomy; Small incision breast surgery; robotic mastectomy.