Robotic-Assisted Nipple Sparing Mastectomy Is Feasible and Safe
Farr DE, Haddock NT, Tellez J, et al. Safety and Feasibility of Single-Port Robotic-Assisted Nipple-Sparing Mastectomy. JAMA Surg. 2024.
Editorial: Morrow M. Robotic Nipple-Sparing Mastectomy—Ready for Prime Time? JAMA Surg. 2024.
Robotic-assisted nipple sparing mastectomy with immediate reconstruction is a potentially useful approach for patients with breast cancer, but multiport robotic devices are difficult to use. Deborah E. Farr, MD, FACS, and coauthors report experience with a single port robotic device for performance of nipple-sparing mastectomy.
This initial case series involved 20 patients treated at a single center. Outcomes of interest included operative time, conversion to open surgery, systemic complications, skin necrosis, and adequacy of sensation of the skin and nipple-areolar complex.
Eleven patients underwent surgery because of a high risk for future breast cancer, and nine patients had confirmed breast cancer. Breast size varied and patient BMI ranged from 19.7 to 24.4. Procedure duration ranged from 205 to 351 minutes.
No conversions to open procedures occurred, and there were no immediate complications (hematoma, positive margins, or early recurrence of cancer). In the first 20 resected breasts sensation was confirmed by measurement at 36 months in 65% of patients. The authors concluded that single-port robotic mastectomy was feasible and safe.
In the editorial that accompanied the article, Monica Morrow, MD, FACS, emphasized that long-term follow-up to determine rates of late cancer recurrence are necessary to confirm the oncologic effectiveness of this procedure.
Biomarker-Directed Thromboprophylaxis Has Value for Patients Undergoing Treatment for Cancer
Alexander M, Harris S, Underhill C, at al. Risk-Directed Ambulatory Thromboprophylaxis in Lung and Gastrointestinal Cancers: The TARGET-TP Randomized Clinical Trial. JAMA Oncol. 2023;9(11):1536-1545.
Editorial: Khorana AA. Primary Thromboprophylaxis in People with Cancer—Where Next? JAMA Oncol. 2023;9(11):1545-1546.
This article reported data from a randomized, prospective trial that evaluated biomarker-directed thromboprophylaxis in patients undergoing treatment for lung and gastrointestinal cancers.
Patients with a history of documented thromboembolism were classified as high risk; biomarker criteria used to identify additional patients at high risk for thromboembolism included d-dimer level >1.5 µg/mL and fibrinogen level >400 mg/dL. Patients were recruited from four Australian hospitals; biomarker measurements were performed at laboratories that were easily accessible by patients.
The patient cohort included 328 patients; 200 patients were classified as high risk. In high-risk patients, thromboprophylaxis was accomplished with enoxaparin; outcomes were compared with control patients who received no thromboprophylaxis. Thromboembolism was confirmed in 8% of patients receiving enoxaparin and 23% of control patients.
Mortality at 6 months of follow-up was significantly lower in high-risk patients who received enoxaparin. Clinically significant bleeding episodes occurred in 1% to 2% of patients in all groups. The authors concluded that risk stratification using biomarkers was a safe and effective way to select patients for thromboprophylaxis during treatment for malignant disease.
In the editorial that accompanied the article, Alok A. Khorana, MD, agreed that biomarker-directed thromboprophylaxis had value for patients undergoing treatment for cancer.
