Surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection with the help of HUAXI Hole 3_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIU Mengxue ¹ , YANG Huanzuo ¹ , ZHOU Jiao ¹ , FENG Yu ¹ , QIN Xiangquan ¹ , LI Juan ^1,2 , LIU Xinran ¹ , XU Li ¹ ,  DU Zhenggui ^1,3

1. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Breast Surgery, Sichuan Academy of Medical Sciences · Sichuan Province People’s Hospital, Chengdu, 610072,P. R. China;
3. Center for Breast Disease Treatment, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Breast cancer; benign breast tumors; endoscopy; breast conserving surgery; breast tumor resection

DOI：

10.7507/1007-4848.202204057

Video：

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Objective To explore the surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection in the treatment of benign and malignant breast tumors. Methods The clinical data of 18 patients received endoscopic breast tumor resection from September 2020 to December 2021 in the Department of Breast Surgery, West China Hospital, Sichuan University, were retrospectively analyzed to evaluate the feasibility, tumor safety and postoperative cosmetic effect. There were 7 patients with benign breast tumors (a benign breast tumor group) and 11 patients with early breast cancer (a malignant breast tumor group). Breast-Q and Scar-Q questionnaires were used to evaluate postoperative quality of life and satisfaction of patients. Results Endoscopic breast tumor resection was performed successfully in 18 female patients, among whom 12 patients received day surgery. The mean age of benign and malignant breast tumor groups was 29.6±11.6 years and 46.7±14.3 years, the mean tumor size in pathological examination was 3.3±2.1 cm and 2.0±0.8 cm, and the operative time was 138.9±57.0 min and 177.3±46.3 min, respectively. One patient had positive resection margin and underwent intraoperative extended resection in the malignant breast tumor group. All the patients were successfully followed up, and the mean follow-up time of benign and malignant breast tumor groups was 6.8±4.0 months and 8.7±4.9 months, respectively. No complications or tumor recurrence occurred. The scores of psychosocial status, sexual well-being, chest wall status and breast satisfaction decreased one month after surgery and basically recovered to the preoperative level in one year, and the score of scar appearance increased to 64.6±5.9 points one year postoperatively. Conclusion Endoscopic assisted transaxillary breast tumor resection can effectively improve postoperative cosmetic effect and patient satisfaction on the premise of safety.

Citation： QIU Mengxue, YANG Huanzuo, ZHOU Jiao, FENG Yu, QIN Xiangquan, LI Juan, LIU Xinran, XU Li, DU Zhenggui. Surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection with the help of HUAXI Hole 3. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 350-356. doi: 10.7507/1007-4848.202204057 Copy

1.	Liu S, Zou JL, Zhou FL, et al. Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: Analysis of 1267 cases. Nan Fang Yi Ke Da Xue Xue Bao, 2017, 37(8): 1121-1125.
2.	Coughlin SS. Epidemiology of breast cancer in women. Adv Exp Med Biol, 2019, 1152: 9-29.
3.	Kimball CC, Nichols CI, Vose JG, et al. Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011-2016. Ann Surg Oncol, 2018, 25(13): 3867-3873.
4.	De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
5.	Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ-Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
6.	Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
7.	Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: A very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
8.	Angarita FA, Castelo M, Englesakis M, et al. Robot-assisted nipple-sparing mastectomy: Systematic review. Br J Surg, 2020, 107(12): 1580-1594.
9.	Mok CW, Lai HW. Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes. Breast, 2019, 46: 144-156.
10.	Ahn SJ, Song SY, Park HS, et al. Early experiences with robot-assisted prosthetic breast reconstruction. Arch Plast Surg, 2019, 46(1): 79-83.
11.	Satake T, Narui K, Muto M, et al. Endoscopic nipple-sparing mastectomy with immediate multistage fat grafting for total breast reconstruction: A new combination for minimal scar breast cancer surgery. Plast Reconstr Surg, 2018, 142(5): 816e-818e.
12.	Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg, 2014, 3(2): 94-108.
13.	Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
14.	Klassen AF, Ziolkowski N, Mundy LR, et al. Development of a new patient-reported outcome instrument to evaluate treatments for scars: The SCAR-Q. Plast Reconstr Surg Glob Open, 2018, 6(4): e1672.
15.	Kim MK, Kim T, Moon HG, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol, 2015, 41(3): 426-432.
16.	Mok CW, Lai HW. Evolution of minimal access breast surgery. Gland Surg, 2019, 8(6): 784-793.
17.	Lai HW, Mok CW, Chang YT, et al. Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol, 2020, 46(8): 1446-1455.
18.	Wang ZH, Ng HI, Teng CS, et al. Outcomes of single-port gasless laparoscopic breast-conserving surgery for breast cancer: An observational study. Breast J, 2019, 25(3): 461-464.
19.	Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol, 2010, 17(5): 1375-1391.
20.	Ozaki S, Ohara M, Shigematsu H, et al. Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A, 2013, 23(2): 91-99.

1. Liu S, Zou JL, Zhou FL, et al. Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: Analysis of 1267 cases. Nan Fang Yi Ke Da Xue Xue Bao, 2017, 37(8): 1121-1125.
2. Coughlin SS. Epidemiology of breast cancer in women. Adv Exp Med Biol, 2019, 1152: 9-29.
3. Kimball CC, Nichols CI, Vose JG, et al. Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011-2016. Ann Surg Oncol, 2018, 25(13): 3867-3873.
4. De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Ann Surg Oncol, 2016, 23(10): 3247-3258.
5. Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ-Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
6. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
7. Kompatscher P. Endoscopic capsulotomy of capsular contracture after breast augmentation: A very challenging therapeutic approach. Plast Reconstr Surg, 1992, 90(6): 1125-1126.
8. Angarita FA, Castelo M, Englesakis M, et al. Robot-assisted nipple-sparing mastectomy: Systematic review. Br J Surg, 2020, 107(12): 1580-1594.
9. Mok CW, Lai HW. Endoscopic-assisted surgery in the management of breast cancer: 20 years review of trend, techniques and outcomes. Breast, 2019, 46: 144-156.
10. Ahn SJ, Song SY, Park HS, et al. Early experiences with robot-assisted prosthetic breast reconstruction. Arch Plast Surg, 2019, 46(1): 79-83.
11. Satake T, Narui K, Muto M, et al. Endoscopic nipple-sparing mastectomy with immediate multistage fat grafting for total breast reconstruction: A new combination for minimal scar breast cancer surgery. Plast Reconstr Surg, 2018, 142(5): 816e-818e.
12. Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg, 2014, 3(2): 94-108.
13. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
14. Klassen AF, Ziolkowski N, Mundy LR, et al. Development of a new patient-reported outcome instrument to evaluate treatments for scars: The SCAR-Q. Plast Reconstr Surg Glob Open, 2018, 6(4): e1672.
15. Kim MK, Kim T, Moon HG, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol, 2015, 41(3): 426-432.
16. Mok CW, Lai HW. Evolution of minimal access breast surgery. Gland Surg, 2019, 8(6): 784-793.
17. Lai HW, Mok CW, Chang YT, et al. Endoscopic assisted breast conserving surgery for breast cancer: Clinical outcome, learning curve, and patient reported aesthetic results from preliminary 100 procedures. Eur J Surg Oncol, 2020, 46(8): 1446-1455.
18. Wang ZH, Ng HI, Teng CS, et al. Outcomes of single-port gasless laparoscopic breast-conserving surgery for breast cancer: An observational study. Breast J, 2019, 25(3): 461-464.
19. Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: A classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol, 2010, 17(5): 1375-1391.
20. Ozaki S, Ohara M, Shigematsu H, et al. Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A, 2013, 23(2): 91-99.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection with the help of HUAXI Hole 3

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