Importance While nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM). Objective To examine the differences in postoperative complications between C-NSM and M-NSM. Design, Setting, Participants This was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024. Exposures M-NSM or C-NSM. Main Outcomes and Measures Clinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications. Results There were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03). Conclusions and Relevance The similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

中文翻译：

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最小入路与传统保留的乳房切除术。


重要性 虽然过去仅使用开放方法进行乳腺癌的保留乳房切除术 （NSM），但使用内窥镜和机器人手术器械的频率一直在迅速增加。然而，关于术后并发症以及微创NSM （M-NSM） 与传统 NSM （C-NSM） 相比的优缺点的研究有限。目的 探讨 C-NSM 与 M-NSM 术后并发症的差异。设计、设置、参与者 这是一项回顾性多中心队列研究，招募了 1583 名 19 岁及以上的女性乳腺癌患者，她们于 2018 年 1 月至 2020 年 12 月期间在韩国 21 所大学医院接受了 NSM。排除了未保留-乳晕复合体 （NAC） 的乳房切除术、NAC 中的临床或病理恶性肿瘤、炎性乳腺癌、浸润胸壁或皮肤的乳腺癌、转移性乳腺癌或病历不足的患者。数据分析时间为 2021 年 11 月至 2024 年 3 月。曝光 M-NSM 或 C-NSM。主要结局和测量 评估术后 3 个月内的临床病理因素和术后并发症。统计分析，包括 logistic 回归，用于确定与并发症相关的因素。结果 有 1356 例 （平均 [SD] 年龄，45.47 [8.56] 岁） 接受 C-NSM，227 例 （平均 [SD] 年龄，45.41 [7.99] 岁） 接受 M-NSM （35 例内窥镜辅助和 192 例机器人辅助）。两组术后短期和远期并发症差异无统计学意义 （<30 天：C-NSM，1356 例中的 465 例 [34.29%] vs M-NSM，227 例中的 73 例 [32.16%];P = .53;<90 天：C-NSM，1356 例中的 525 例 [38.72%] vs M-NSM，227 例中的 73 例 [32.16%];P = .06）.-乳晕复合体坏死在 C-NSM 后的长期内比 M-NSM 更常见 （C-NSM，1356 例中的 91 例 [6.71%] vs M-NSM，227 例中的 5 例 [2.20%];P = .04）。M-NSM 后伤口感染发生率更高 （C-NSM，1356 例中的 58 例 [4.28%] vs M-NSM，227 例中的 18 例 [7.93%];P = .03）。C-NSM 后术后血清肿发生率更高 （C-NSM，1356 例中的 193 例 [14.23%] vs M-NSM，227 例中的 21 例 [9.25%];P = .04）。轻度或重度乳腺下垂是或乳晕坏死的重要危险因素 （比值比 [OR]，4.75;95% CI，1.66-13.60;P = .004 和 OR，8.78;95% CI，1.88-41.02;P = .006）。相反，使用腋中、腋前或腋窝切口与较低的坏死风险相关（OR 对于其他切口，32.72;95% CI，2.11-508.36;P = .01）。与其他乳房重建相比，直接植入式乳房重建的坏死发生率显著降低 （OR， 2.85;95% CI， 1.11-7.34;P = .03）。结论和相关性C-NSM 和 M-NSM 之间相似的并发症发生率表明，两种方法同样安全，可以根据患者的偏好和特定需求进行选择。