No laparoscopic-related complications such as subcutaneous emphysema were observed. The mean incision length was 3.4 cm in the SIE-BCS group and 8.6 cm in the C-BCS group. The difference between the two groups was statistically significant (t = 19.59, p < 0.001) (Table 2). The difference in mean operation time between the two groups was statistically significant (T = 8.788, p < 0.001) (Table 2). The difference in mean operation time in lateral quadrant and medial quadrant surgeries in both groups was not statistically significant (SIE-BCS group: t=-0.343, p = 0.733; C-BCS group: t=-0.716, p = 0.475). The difference in mean operation time between the two groups was not statistically significant. None of the patients in the SIE-BCS group had positive pathological resection margins. However, two patients (1.7%) in the C-BCS group were initially positive during operation. However, after an additional resection, the resection margin was negative for residual tumor cells. Postoperative pathological resection margins were negative in all patients.
Table 2
Perioperative clinicopathologic features of patients
Variable | SIE-BCS | C-BCS | p-value |
---|
SLNB or ALND, n (%) | | | 0.452 |
SLNB only | 49 (77.8%) | 85 (72.6%) | |
SLNB and ALND | 14 (22.2%) | 32 (27.4%) | |
Operation time (min) | 194.9 (59.0-410.0) | 140.3 (21.0-400.0) | < 0.001 |
Intraoperative blood loss (mL) | 24.3 (5.0-100.0) | 20.9 (2.0–50.0) | 0.701 |
pTNM staging, n (%) | | | 0.672 |
pT1 | 45 (71.4%) | 80 (73.8%) | |
pT2 | 18 (28.6%) | 37 (26.2%) | |
pTNM staging, n (%) | | | 0.517 |
pN0 | 46 (73.0%) | 80 (68.4%) | |
pN1 | 17 (27.0%) | 37 (31.6%) | |
Degree of tumor differentiation, n (%) | | | 0.930 |
G1 | 6 (9.5%) | 12 (10.3%) | |
G2 | 52 (82.5%) | 94 (80.3%) | |
G3 | 5 (8.0%) | 11 (9.4%) | |
Tumor types, n (%) | | | 0.731 |
Invasive ductal carcinoma | 54 (85.7%) | 102 (87.2%) | |
Mucinous carcinoma | 3 (4.8%) | 3 (2.6%) | |
Preinvasive carcinoma | 6 (9.5%) | 12 (10.2%) | |
Size of tumor (cm) | 1.90 (0.60–3.20) | 1.95 (0.60-4.00) | 0.440 |
Intraoperative cryosection of the tumor, n (%) | | | 0.542 |
Positive | 0 | 2 (1.7%) | |
Negative | 63 (100%) | 115 (98.3%) | |
Margin of the tumor, n (%) | | | |
Positive | 0 | 0 | |
Negative | 63 (100%) | 117 (100%) | |
Incision length (cm) | 3.4 (2.5-4.0) | 8.6 (8.0–15.0) | < 0.001 |
Drainage duration (day) | 4.3 (1.0–10.0) | 4.4 (2.0–8.0) | 0.596 |
Total drainage volume (mL) | 124.5 (14.0-517.0) | 87.5 (8.0-250.0) | 0.041 |
Local recurrence, n (%) | 2 (3.2%) | 0 | 0.121 |
Metastasis, n (%) | 1 (1.5%) | 6 (5.1%) | 0.424 |
SIE-BCS: Single-port insufflation endoscopic breast-conserving surgery; C-BCS: Conventional breast-conserving surgery; SLNB: Sentinel lymph node biopsy; ALND: Axillary lymph node dissection; pTNM: Pathological tumor, node, metastasis. |
In the SIE-BCS group, 49 patients underwent sentinel lymph node biopsy only. The average number of sentinel lymph nodes was 4.63. The other 14 patients underwent axillary dissection. The mean number of axillary lymph nodes was 15.21. In the C-BCS group, 85 patients underwent sentinel lymph node biopsy, with an average sentinel lymph node number of 4.38. The other 32 patients underwent axillary dissection, with an average of 14.69 axillary lymph nodes detected (Table 2).
Six months after the surgery, we conducted a questionnaire survey using the BREAST-Q scale on all of the patients from the two groups. The differences between the scores in the SIE-BCS group and the C-BCS group for adverse effects of radiation (46.2 ± 27.2 vs 60.1 ± 23.1, respectively, p = 0.030), chest well-being (85.2 ± 19.8 vs 64.7 ± 15.8, respectively, p < 0.001), and psychological well-being (86.9 ± 16.4 vs 75.2 ± 19.2, respectively, p = 0.006) were statistically significant. The differences between the scores in the SIE-BCS group and C-BCS group for satisfaction of breasts (73.7 ± 18.3 vs 68.8 ± 15.9, respectively, p = 0.120) and sexual well-being (61.6 ± 28.1 vs 64.1 ± 24.0, respectively, p = 0.600) were not statistically significant. (Table 3).
Table 3
BREAST-Q scale score of patients
| SIE-BCS group (n = 63) | C-BCS group (n = 117) | p-value |
---|
Adverse effects of radiation | 46.2 ± 27.2 | 60.1 ± 23.1 | 0.003 |
Chest well-being | 85.2 ± 19.8 | 64.7 ± 15.8 | < 0.001 |
Psychological well-being | 86.9 ± 16.4 | 75.2 ± 19.2 | 0.006 |
Satisfaction of breasts | 73.7 ± 18.3 | 68.8 ± 15.9 | 0.120 |
Sexual well-being | 61.6 ± 28.1 | 64.1 ± 24.0 | 0.600 |
BREAST-Q® VERSION 2.0 © Memorial Sloan Kettering Cancer Center and The University of British Columbia, 2017. SIE-BCS: Single-port insufflation endoscopic breast-conserving surgery; C-BCS: Conventional breast-conserving surgery. |
The patients were followed up until October 2020.
Two patients in the SIE-BCS group had local recurrence (3.2%), while no patients in the C-BCS group had local recurrence (0%). One patient in the SIE-BCS group had metastasis (1.6%), while six patients in the C-BCS group had metastasis (5.1%) (Table
2). The differences between the SIE-BCS group and C-BCS group for local recurrence (
p = 0.121) and metastasis (
p = 0.424) were not statistically significant.
Different surgical methods, tumor size, age, and HER2 status were included in logistic regression analysis. The surgical method choice of SIE-BCS did not increase the risk of local recurrence or metastasis [odds ratio (OR) = 0.975, 95% confidence interval (CI): 0.229, 4.149, p = 0.973]. Tumor size (OR = 1.221, 95%CI: 0.516, 2.887, p = 0.650), age (OR = 1.013, 95%CI: 0.944, 1.088, p = 0.717), and HER2 status (OR = 1.305, 95%CI: 0.250, 6.815, p = 0.752) were not independent risk factors for local recurrence and metastasis in this study (Table 4).
Table 4
Logistic analysis of multiple factors associated with local recurrence and metastasis
Variable | Wald | p-value | OR | 95%CI |
---|
SIE-BCS | 0.001 | 0.973 | 0.975 | 0.229, 4.149 |
Tumor size (cm) | 0.206 | 0.650 | 1.221 | 0.516, 2.887 |
Age | 0.131 | 0.717 | 1.013 | 0.944, 1.088 |
HER2 positivity | 0.100 | 0.752 | 1.305 | 0.250, 6.815 |
OR: Odds ratio; CI: Confidence interval; SIE-BCS: Single-port insufflation endoscopic breast-conserving surgery. |