medwireNews: Minimal access breast surgery (MABS) offers comparable long-term outcomes to conventional surgery for women with stage 0–III breast cancer, show the results of a propensity-matched, retrospective cohort study.
“MABS provides the advantages of less trauma, good cosmetic results, functional preservation, and high patient satisfaction,” say Yi Zhang and co-authors, based at Southwest Hospital in Chongqing, China.
When taken together with the demonstrated favorable oncologic outcomes, “MABS may offer a valid alternative surgical option” for patients with early breast cancer, they write in JAMA Surgery.
The investigators collated data for 6175 patients with unilateral stage 0–III breast cancer who underwent surgery at their hospital between 2004 and 2017.
After propensity score matching to minimize selection bias, the team analysed data for 603 women who underwent endoscopic (n=289), endoscopy-assisted (n=302) or robot-assisted (n=12) procedures, and 1809 women who underwent conventional surgery. The groups were followed up for a median of 84 and 80 months, respectively.
Zhang et al report that the MABS and conventional surgery patient groups did not significantly differ with regard to the 10-year rates of freedom from local recurrence (93.3 vs 96.3%), regional recurrence (95.5 vs 96.7%), and distant metastases (81.0 vs 82.0%).
The MABS and conventional surgery arms also had comparable disease-free survival rates at 5 years (85.9 vs 85.0%), 10 years (72.6 vs 76.6%), and 15 years (69.1 vs 70.7%). And the corresponding rates for overall survival were similar at 5 years (92.0 vs 93.6%), 10 years (83.7 vs 88.7%), and 15 years (83.0 vs 81.0%).
Type of surgery was not a significant predictor of disease-free or overall survival in univariate analysis, the researchers say, highlighting that this result “differs from the results of previous studies in which individuals with early cervical cancer who underwent minimally invasive surgery showed a higher risk of recurrence and mortality than those who underwent open surgery.”
Nor did multivariate analysis indicate a significant difference in survival outcomes by surgery arm, and exploratory post-hoc analysis on matched data for patients indicated no significant difference in disease-free survival between the treatment groups.
Zhang and co-authors note the need for large multicenter, prospective studies with longer follow-up to confirm the oncologic safety of MABS for early breast cancer but propose that “MABS may be a safe and feasible alternative in this patient population.”
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