title: Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group.
abstract: BACKGROUND
  Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.
  
  
  METHODS
  The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.
  
  
  RESULTS
  A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3-68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death.
  
  
  CONCLUSIONS
  The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique in the field of breast cancer.
authors.affiliation: Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Division of General Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|School of Medicine, National Yang Ming University, No.155, Sec.2, Linong Street, Taipei, 112 Taiwan (R.O.C.).
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Lai
authors.affiliation: Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Division of General Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
authors.forename: Shou-Tung
authors.initials: ST
authors.lastname: Chen
authors.affiliation: Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Division of General Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
authors.forename: Dar-Ren
authors.initials: DR
authors.lastname: Chen
authors.affiliation: Endoscopy & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan and Dou-Liou branch, N0. 138, Sheng Li Road, Tainan, 704 Taiwan (R.O.C.).
authors.forename: Tsai-Wang
authors.initials: TW
authors.lastname: Chang
authors.affiliation: Division of General Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).|Comprehensive Breast Cancer Center, Department of Surgery, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua, 500 Taiwan (R.O.C.).
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Kuo
authors.affiliation: Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan and Dou-Liou branch, N0. 138, Sheng Li Road, Tainan, 704 Taiwan (R.O.C.).
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Kuo
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252, Wu Hsing Street, Taipei, 110 Taiwan (R.O.C.).
authors.forename: Chin-Sheng
authors.initials: CS
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000639:trends*; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D012008:Recurrence; D013624:Taiwan; D016896:Treatment Outcome; D055815:Young Adult