title: Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy.
abstract: OBJECTIVE
  Endoscopic nipple-sparing mastectomy (E-NSM) has been reportedly associated with smaller scars and greater patient satisfaction; however, long-term results of this procedure have not been made. The purpose of this retrospective study was to investigate the local recurrence (LR) rate and factors associated with it after E-NSM and to examine the oncologic safety of this procedure.
  
  
  METHODS
  We reviewed the medical records of a total of 421 breasts in 404 patients who underwent E-NSM to investigate the LR rate and the factors associated with it. The clinico-pathological features and the treatment and outcomes of the patients with LRs were also examined.
  
  
  RESULTS
  Eleven breasts (2.6 %) in 11 patients presented with LR as the first site of recurrence after a median follow-up time of 61 months. Among the 11 LRs, 9 patients presented with LR only, 1 patient exhibited regional lymph node recurrence, and 1 patient exhibited distant metastasis. The median time from surgery until LR was 25 months. Eight LRs developed near the original tumor site. The risk factors for LR in a multivariate analysis were a younger age of less than 40 years (p = 0.02), Stage III tumor (p = 0.01), and an inadequate surgical margin (p = 0.001). After the treatment, 6 patients had no evidence of disease, 2 patients died from metastatic disease, 2 patients experienced repeat LR, and the remaining patient who rejected excision exhibited a persistent LR.
  
  
  CONCLUSIONS
  E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy.
authors.affiliation: Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan. ns39jp@yahoo.co.jp.
authors.forename: Naomi
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Fukuma
authors.affiliation: Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Teraoka
authors.affiliation: Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
authors.forename: Kazuei
authors.initials: K
authors.lastname: Hoshi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009558:Nipples / Q000601:surgery*; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Breast cancer recurrence; Endoscopic surgery; Local recurrence; Nipple involvement; Nipple-sparing mastectomy