Surgical Safety of Minimally Invasive Surgery Compared to Conventional Nipple-Sparing Mastectomy: A Meta-Analysis and Systematic Reviews.

Abstract

In recent years, endoscopy- and robot-assisted surgical techniques have been progressively incorporated into breast cancer treatment, leading to the enhancement of minimally invasive nipple-sparing mastectomy (M-NSM) procedure. To date, studies comparing the surgical complications, benefits, and drawbacks of M-NSM with those of conventional nipple-sparing mastectomy (C-NSM) remain sparse. Electronic searches of PubMed, Embase, and Web of Science databases were performed. Log-rank statistics were used to compare the effects of M-NSM and C-NSM on various outcomes and estimate first-event-rate risk ratio and 95% confidence interval (CI). This study evaluated surgical safety based on postoperative complication rate. Surgical safety was evaluated by calculating the incidence of postoperative complications following each surgical approach, including overall complications, ischemia/necrosis of the nipple-areola complex, hematoma, infection, and implant-related complications. Based on a meta-analysis of 7 studies involving 3,426 patients, the overall postoperative complication rate (relative risk [RR], 0.84; 95% CI, 0.72-0.97) and rate of nipple-areolar complex (NAC) necrosis (RR, 0.55; 95% CI, 0.32-0.97) for M-NSM were slightly lower than those for C-NSM. The surgical safety of M-NSM may be comparable to or even superior to that of C-NSM, but confirmation via high-quality randomized controlled studies is required.