Long-Term Outcomes With Minimal-Access vs Conventional Breast Surgery in Stage 0 to III Breast Cancer

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In a Chinese single-center, retrospective cohort, propensity score–matched analysis reported in JAMA Surgery, Wan et al found no difference in long-term outcomes, including distant metastasis–free and overall survival, with minimal-access breast surgery vs conventional breast surgery in women with stage 0 to III breast cancer.

Study Details

The study included women undergoing breast cancer surgery between January 2004 and December 2017 at Southwest Hospital, the First Affiliated Hospital of the Army Medical University, Chongqing. Inclusion criteria included age 18 to 75 years, stage 0 to III disease, unilateral surgery, no distant metastasis, and no history of breast cancer or severe underlying disease before surgery.

After propensity-score matching, the analysis included 603 patients undergoing minimal-access breast surgery (endoscopic, endoscopy-assisted, or robot-assisted procedures in 289, 302, and 12 patients, respectively) and 1,809 patients undergoing conventional breast surgery. Patients had a median age of 44 years (interquartile range [IQR] = 40–49 years).

Key Findings

Median follow-up was 84 months (IQR = 45–112 months). For the minimal-access breast surgery vs conventional breast surgery groups, no significant differences were observed in 10-year local recurrence-free survival (93.3% vs 96.3%; hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 0.86–2.27, P = .18), regional recurrence-free survival (95.5% vs 96.7%; HR = 1.38, 95% CI = 0.81–2.36, P = .23), or distant metastasis–free survival (81.0% vs 82.0%; HR = 0.95, 95% CI = 0.74–1.23, P = .72).

No significant difference was observed for minimal-access breast surgery vs conventional breast surgery in disease-free survival (HR = 1.07, 95% CI = 0.86–1.31, P = .55), with 5-, 10-, and 15-year rates of 85.9% vs 85.0%, 72.6% vs 76.6%, and 69.1% vs 70.7%, respectively. No significant difference was observed in overall survival (HR = 1.29, 95% CI = 0.97–1.72, P = .09), with 5-, 10-, and 15-year rates of 92.0% vs 93.6%, 83.7% vs 88.7%, and 83.0% vs 81.0%.

The investigators concluded, “In this cohort study, long-term outcomes following minimal-access breast surgery were not significantly different from those following conventional breast surgery in patients with early-stage breast cancer. Minimal-access breast surgery may be a safe and feasible alternative in this patient population.”

Yi Zhang, MD, and Xiaowei Qi, MD, of the First Affiliated Hospital of the Army Military Medical University, Chongqing, are the corresponding authors for the JAMA Surgery article.

Disclosure: The study was funded by the Talent Plan in Chongqing, Technical Innovation and Application Development in Chongqing, and Foundation of Army Medical University. For full disclosures of the study authors, visit

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