Surgical outcomes and postoperative complications of robotic versus conventional nipple-sparing mastectomy in breast cancer: A meta-analysis.

Abstract

585 Background: Breast cancer is the most common type of cancer, affecting millions of women worldwide. Nipple-sparing mastectomy has emerged as a technique that leaves most of the healthy breast skin, areola, and nipple. This technique is widely used but there is little evidence comparing conventional and robotic nipple-sparing mastectomy. This meta-analysis aimed to compare the efficacy, safety, and postoperative complications of conventional and robotic nipple-sparing mastectomy. Methods: A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted to identify studies comparing robotic and conventional nipple-sparing mastectomy. The primary outcome was nipple and skin necrosis; secondary outcomes included operative time and Clavien-Dindo Grade III complications. Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I2 statistic. Results: A total of nine studies encompassing 1,220 participants (423 in the robotic group and 797 in the conventional group) were included in the final analysis. Robotic nipple-sparing mastectomy (RNSM) was associated with a significantly lower risk of nipple and skin necrosis compared to conventional nipple-sparing mastectomy (CNSM), with a pooled odds ratio of 0.47 (95% CI: 0.26–0.86; P = 0.01) and low heterogeneity (I2 = 20.5%). Conversely, RNSM was associated with a significantly longer operative time, with a weighted mean difference of 52.86 minutes (95% CI: 20.28–85.43; P = 0.001) and substantial heterogeneity (I2 = 96%). Regarding safety, there was no statistically significant difference in Clavien-Dindo Grade III complications between the two techniques (OR = 0.60; 95% CI: 0.35–1.05; P = 0.07; I2 = 0%), although the results showed a trend favoring the robotic approach. Conclusions: Robotic nipple-sparing mastectomy demonstrates a superior safety profile regarding ischemic complications, significantly reducing the risk of nipple and skin necrosis compared to the conventional approach. However, it is associated with longer operative times. The incidence of major complications (Grade III) is comparable between both techniques.