Description:
Nipple-sparing mastectomy (NSM) with immediate reconstruction is one of the standard of care
surgical treatments of breast cancer (BC) and is used for risk reduction in patients with a
high risk for BC. While this method shows satisfactory oncologic and good cosmetic outcomes,
its drawbacks include compromise of the skin flap vascularization due to skin incision,
nipple-areolar complex (NAC) malposition/distortion and visible scar on the breast. NSM also
has technical challenges of dissecting and removing larger specimens through limited
incisions and concerns regarding oncologic effectiveness due to difficulties in visualizing
regions of the breast remote from the incision. To improve cosmetic outcomes after NSM, a
modification of this technique using a surgical robotic system was recently described. In a
limited number of studies, the robotic NSM (RNSM) with immediate prosthetic breast
reconstruction (IPBR) was shown to be feasible and safe, as well as led to excellent cosmetic
outcomes and patient satisfaction. There are limited number of centers in North America and
none in Canada that offer RNSM-IPBR. The investigators hypothesize that RNSM-IPBR is a
feasible and safe technique that can be utilized in our institution and that it can provide
superior cosmetic outcomes with less morbidity and higher patient satisfaction compared to
the traditional NSM-IPBR. The aim is to conduct a single-arm prospective study to investigate
the safety and feasibility, as well as cosmetic, surgical complication and patient
satisfaction parameters of NSM-IPBR performed in the University Health Network (UHN). This
study will serve a foundation for potential introduction of a novel surgical approach in our
institution and will make it available for treatment and prevention of breast cancer in
Canadian women. The study will also serve as pilot data for future potential studies,
including randomized-controlled trials (RCT) comparing RNSM with conventional NSM. As such,
the study will further our approach to innovation in breast surgical oncology within Canada
and North America.
Title
- Brief Title: Surgical and Patient Reported Outcomes of Robotic Nipple-Sparing Mastectomy
- Official Title: Robotic Nipple-Sparing Mastectomy With Immediate Prosthetic Breast Reconstruction: Prospective Study of Feasibility, Safety and Patient Satisfaction, Toronto Experience.
Clinical Trial IDs
- ORG STUDY ID:
19-5250.0
- NCT ID:
NCT04151368
Conditions
- Breast Cancer
- Surgery--Complications
- Genetic Predisposition to Disease
- Surgery
- BRCA1 Mutation
- BRCA2 Mutation
- Breast Diseases
Purpose
Nipple-sparing mastectomy (NSM) with immediate reconstruction is one of the standard of care
surgical treatments of breast cancer (BC) and is used for risk reduction in patients with a
high risk for BC. While this method shows satisfactory oncologic and good cosmetic outcomes,
its drawbacks include compromise of the skin flap vascularization due to skin incision,
nipple-areolar complex (NAC) malposition/distortion and visible scar on the breast. NSM also
has technical challenges of dissecting and removing larger specimens through limited
incisions and concerns regarding oncologic effectiveness due to difficulties in visualizing
regions of the breast remote from the incision. To improve cosmetic outcomes after NSM, a
modification of this technique using a surgical robotic system was recently described. In a
limited number of studies, the robotic NSM (RNSM) with immediate prosthetic breast
reconstruction (IPBR) was shown to be feasible and safe, as well as led to excellent cosmetic
outcomes and patient satisfaction. There are limited number of centers in North America and
none in Canada that offer RNSM-IPBR. The investigators hypothesize that RNSM-IPBR is a
feasible and safe technique that can be utilized in our institution and that it can provide
superior cosmetic outcomes with less morbidity and higher patient satisfaction compared to
the traditional NSM-IPBR. The aim is to conduct a single-arm prospective study to investigate
the safety and feasibility, as well as cosmetic, surgical complication and patient
satisfaction parameters of NSM-IPBR performed in the University Health Network (UHN). This
study will serve a foundation for potential introduction of a novel surgical approach in our
institution and will make it available for treatment and prevention of breast cancer in
Canadian women. The study will also serve as pilot data for future potential studies,
including randomized-controlled trials (RCT) comparing RNSM with conventional NSM. As such,
the study will further our approach to innovation in breast surgical oncology within Canada
and North America.
Detailed Description
This is a single-arm prospective study to assess feasibility and safety (primary outcomes),
as well as patient satisfaction, cosmetic and oncologic outcomes of RNSM-IPBR in women with
BC or at high risk of BC treated at UHN.
The objectives of the study are to determine:
1. Feasibility of RNSM-IPBR through assessing operative parameters (such as time of
procedure, robot docking time, conversion to conventional NSM-IPBR).
2. Safety of RNSM-IPBR through assessing rate of morbidity from surgical complications
(such as wound infection, flap and NAC necrosis, postoperative hematoma/bleeding, seroma
requiring aspiration, implant loss, anesthesia related complications and need for
reoperation with one month due to complications) and mortality due to the procedure.
3. Patient satisfaction from RNSM-IPBR through assessing psychological, physical, sexual
well-being, as well as satisfaction with breast, overall outcome and care through
patient reported outcomes.
4. Cosmetic outcomes of RNSM-IPBR, such as distortion or malposition of NAC and scarring,
rate of reoperation due to unacceptable cosmetic outcomes.
5. Short- and long-term oncologic outcomes of NSM-IPBR, such as positivity of margins,
breast cancer incidence and recurrence rate, as well as overall survival.
The rationale of the study is to investigate a novel technique of RNSM-IPBR that might have
superior cosmetic and patient satisfaction outcomes, as well as lower rates of complications,
based on a small number of previously published studies from Europe and Asia.
Once enrolled, clinical, radiologic, and pathologic data will be collected for each
participant at the initial visit and follow up data will be collected via available
electronic patient records.
RNSM-IPBR will be performed by previously described method (Toesca et al.) using an
extra-mammary axillary incision along the mid-axillary line in the axillary fossa. We will
use Da Vinci Si Surgical System® (Intuitive Surgical, Sunnyvale, CA) available at Toronto
General Hospital, UHN.
Trial Arms
Name | Type | Description | Interventions |
---|
Robotic Nipple Sparing Mastectomy Arm | Experimental | Patient cohort undergoing nipple sparing mastectomy with use of robotic dissection. | |
Eligibility Criteria
Inclusion Criteria:
- Women of any age with invasive breast cancer (BC), ductal carcinoma in situ (DCIS),
BRCA or other breast cancer genetic mutation carriers or high risk BC female patients
who are otherwise candidates for NSM with IPBR will be eligible for the study. For
those patients, RNSM-IPBR will be offered. Those who, after thorough discussion of
risks and benefits, choose and consent to undergo RNSM-IPBR will be included in the
study.
Exclusion Criteria:
- Heavy smokers (>20 cigarettes a day)
- Uncompensated Diabetes Mellitus
- High risk for anesthesia (ASA 4)
- Inflammatory Breast Cancer
- Previous thoracic radiation therapy for any reason
- Pregnancy
- Psychiatric, addictive, or any disorder which compromises ability to give informed
consent for participation in this study
Maximum Eligible Age: | 75 Years |
Minimum Eligible Age: | 20 Years |
Eligible Gender: | Female |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Feasibility of RNSM |
Time Frame: | 1 month |
Safety Issue: | |
Description: | Surgical time in minutes |
Secondary Outcome Measures
Measure: | Patient Satisfaction |
Time Frame: | Pre-Operative and 6 and 12 months post-operative |
Safety Issue: | |
Description: | Breast Q Pre and Post-operative Surveys- items measuring satisfaction with appearance, surgical experience, breast shape and symmetry, psychosocial, physical and sexual well being. Lowest score = 0, highest = 100 with higher scores indicating better outcomes / quality of life. |
Measure: | Body Image |
Time Frame: | 6 months post-operative |
Safety Issue: | |
Description: | Hopwood's Body Image Scale- Scores range from 0 (min distress) to 3 (max distress) for 10 questions. Lowest score = 0, highest = 30 with lower scores indicated lower body image distress. |
Details
Phase: | N/A |
Primary Purpose: | Interventional |
Overall Status: | Suspended |
Lead Sponsor: | University Health Network, Toronto |
Trial Keywords
- breast surgery
- robotic surgery
- nipple sparing mastectomy
- genetic predisposition
- breast cancer
Last Updated
April 22, 2021