This study is a multicenter, open-label, randomized controlled trial. The study aims to evaluate differences in operative efficiency (e.g., operative time), economic effect, surgical safety (e.g., surgical complication rates), postoperative aesthetics (e.g., BREAST-Q scores, Harris scores, SCAR-Q scores and Ueda scores), and oncological safety (e.g., margin status, no local recurrence survival) between patients undergoing M-E-BCS and patients undergoing C-O-BCS.
Breast cancer is a highly prevalent malignant tumor among women, and comprehensive treatment mainly based on surgery is the main mode. Breast aesthetics is important, breast-conserving surgery (BCS) is a common surgical approach, which can preserve the breast shape, does not affect subsequent treatment, and has been confirmed to be safe in terms of oncology. Conventional open breast-conserving surgery (C-O-BCS) requires multiple incisions, resulting in prominent scars. With the introduction of minimally invasive techniques, endoscopic breast-conserving surgery (E-BCS) has emerged as an alternative. It reduces the number of incisions, lowers the incidence of complications, and enhances aesthetic outcomes and patient satisfaction, while maintaining similar oncological safety compared to open surgery. However, single-incision E-BCS is limited by restricted operative space, making precise tumor resection and oncoplastic procedures challenging. Although multi-incision E-BCS facilitates surgical procedures, it does not improve scar aesthetics and may increase surgical trauma and costs. As a result, the adoption of endoscopic breast-conserving surgery has been limited, and there is a lack of high-quality clinical studies in this area. Our team proposed the minimal accessory-incision-assisted endoscopic breast-conserving surgery (M-E-BCS), which has concealed incisions, strong operability, and good cosmetic effects. It is being popularized in China. To comprehensively evaluate its clinical benefits, large-scale multicenter studies are needed to provide evidence-based medical evidence and optimize surgical plans. Therefore, this national multicenter, open-label, randomized controlled trial will compare outcomes between patients undergoing M-E-BCS versus C-O-BCS. The study aims to evaluate differences in operative efficiency (e.g., operative time), economic effect, surgical safety (e.g., surgical complication rates), postoperative aesthetics (e.g., BREAST-Q scores, Harris scores, SCAR-Q scores and Ueda scores), and oncological safety (e.g., margin status, no local recurrence survival).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,366
A small incision was made in the concealed area of the armpit, and a endoscopic device was inserted. Under direct vision, the tumor was precisely removed and the lymph nodes in the armpit were cleared layer by layer. The incision was then sutured layer by layer, and a drainage tube was placed after the operation.
Conventional open breast-conserving surgery is a surgical approach that aims to preserve the appearance and function of the breast as much as possible while ensuring the complete removal of the tumor. It is suitable for eligible patients with early-stage breast cancer and requires comprehensive postoperative treatment measures such as radiotherapy.
West China hospital of Sichuan University
Chengdu, Sichuan, China
Local recurrence rates
The risk of local recurrence within five years.
Time frame: Postoperative 5 years
Surgical efficiency
Total operative time (min) from skin incision to complete closure of incision, the operative time for axillary surgery and the operative time for breast surgery.
Time frame: Intraoperative
Economic effect
The total cost from the patient's admission to discharge, the surgery fee and the hospitalization fee (USD).
Time frame: 1 month postoperative
Surgical safety
Surgical complication rates, major complication rates and minor complication rates, including flap scald, NAC ischemia/necrosis, seroma, surgical area infection, bleeding, incision splitting, flap ischemia/necrosis.
Time frame: Intraoperative, 3 months postoperative.
Aesthetic outcomes (BREAST-Q score)
The BREAST-Q scores range from 0 to 100, with higher scores indicating better outcomes. Both raw questionnaire scores and standardized transformed scores will be documented, along with pre- to postoperative differences in transformed scores.
Time frame: Preoperative, 6 months postoperative, 2 years postoperative and 5 years postoperative.
Aesthetic outcome (Harris score)
The Harris score was used to record the subjective judgment of symmetry of the reconstructed breast compared to the contralateral breast. The results were categorized as excellent (treated breast nearly identical to untreated breast), good (treated breast slightly different than untreated), fair (treated breast clearly different than untreated), and poor (treated breast seriously distorted).
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Time frame: Preoperative, 6 months postoperative, 2 years postoperative and 5 years postoperative.
Aesthetic outcome (Ueda score)
Doctor-reported aesthetic outcomes will be evaluated by three professional breast surgeons using the Ueda scale, based on postoperative photographs. Scores range from 0 to 10 points, with higher values indicating better results. The categorized as follows: Excellent (≥9 points), Good (7-8 points), Fair (5-6 points), Poor (≤4 points). Both raw scores and categorizations will be documented.
Time frame: Preoperative, 6 months postoperative, 2 years postoperative and 5 years postoperative.
Aesthetic outcome (SCAR-Q score)
A validated scar-specific patient-reported outcome measure tool for assessing the quality of life of patients with scars. It consists of three independent scales: scar appearance, scar symptoms, and psychosocial impact. Transformed scores range from 0 to 100, with higher scores indicating better outcomes.
Time frame: Preoperative, 6 months postoperative, 2 years postoperative and 5 years postoperative.
Surgical margin involvement
Surgical margin involvement was defined as ink on tumor on postoperative paraffin-embedded pathological examination.
Time frame: 2-3 weeks postoperative after paraffin-embedded pathological report available.
Resection mastectomy weight
Mean mastectomy weight (g)
Time frame: Immediate postoperative
Local Recurrence-Free Survival(LRFS)
The time interval from initiation of treatment to the first recurrence at the primary tumor site. If local recurrence appears, record the time and location of recurrence.
Time frame: 2 years postoperative and 5 years postoperative.
Regional Recurrence-Free Survival (RRFS)
The time from the date of diagnosis or treatment to the date of first regional recurrence (recurrence in the ipsilateral regional lymph nodes, including axillary, internal mammary, or supraclavicular nodes) or death from any cause, whichever occurs first.
Time frame: 2 years postoperative and 5 years postoperative.
Distant Metastasis-Free Survival (DMFS)
The time from the date of diagnosis or treatment to the date of first distant metastasis (spread to distant organs such as bone, lung, liver, or brain) or death from any cause, whichever occurs first.
Time frame: 2 years postoperative and 5 years postoperative.
Progression-Free Survival (PFS)
The time from the date of initiation of systemic therapy (or randomization in clinical trials) to the date of first documented disease progression (either local, regional, or distant recurrence) or death from any cause, whichever occurs first.
Time frame: 2 years postoperative and 5 years postoperative.
Disease-Free Survival(DFS)
The period from treatment initiation to any disease recurrence (local, regional, or distant) or death.If above event appears, record the time and disease location.
Time frame: 2 years postoperative and 5 years postoperative.
Breast Cancer-Specific Survival (BCSS)
The time from the date of diagnosis to the date of death specifically attributed to breast cancer. Deaths from other causes are considered competing events and are censored.
Time frame: 2 years postoperative and 5 years postoperative.
Overall Survival(OS)
The time from treatment initiation (or diagnosis) to death from any cause. If death appears, record the time and reason.
Time frame: 2 years postoperative and 5 years postoperative.