Endoscopic Mastectomy: A Cost-Effective and Time-Efficient Alternative to Robotic Mastectomy With Comparable Oncologic and Safety Outcomes

초록

Purpose: Nipple-sparing mastectomy (NSM) with immediate reconstruction is one of the most widely selected approaches for total mastectomy in patients with breast cancer who desire breast reconstruction. With the introduction of endoscopic nipple-sparing mastectomy (EM) and robotic nipple-sparing mastectomy (RM), comparison of these techniques in terms of clinical outcomes, surgical efficiency, and cost-effectiveness has gained increasing attention. Here, we compared the EM and RM techniques. Methods: This study included 110 patients who underwent RM (n = 29) or EM (n = 81) at Korea University Ansan Hospital between April 2019 and November 2024. Primary outcomes were surgical time, surgical cost, length of hospital stay, total drainage, and complication rates. Statistical analyses were performed to compare differences between the two groups. Results: There were significant differences in both mastectomy operative time (RM: 170.7 +/- 55.2 minutes, EM: 149.9 +/- 40.2 minutes; p = 0.033) and reconstruction operative time (RM: 213.6 +/- 110.1 minutes, EM: 119.2 +/- 77.9 minutes; p < 0.001), resulting in a significantly longer total operative time for RM (RM: 384.3 +/- 113.0 minutes, EM: 269.0 +/- 89.0 minutes; p < 0.001). RM was also significantly more expensive than EM (RM: 31,338,659.0 +/- 5,166,816.8 KRW, EM: 19,486,521.5 +/- 6,074,413.6 KRW; p < 0.001). Length of hospital stay, complication rates, and short-term oncological outcomes did not differ significantly between the two groups. Conclusion: EM is a more time-efficient and cost-effective surgical technique than RM. Our findings indicate no significant safety advantage of RM over EM, highlighting the need for individualized surgical decision-making.

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