Endoskopi Yardımlı Onkoplastik Meme Cerrahisi (EYOMC)
Özet
Endoskopi Yardımlı Onkoplastik Meme Cerrahisi (EYOMC), meme kanserinin lokal tedavisinde estetik sonuçları optimize etmek amacıyla geliştirilen, minimal invaziv bir cerrahi yaklaşımdır. Tarihsel gelişimi 1990'ların sonuna uzanan bu yöntem, özellikle Japonya ve Güney Kore gibi Asya ülkelerinde küçük meme hacmine sahip T1-T2 tümörlü olgularda yaygınlık kazanmıştır. Hem meme koruyucu cerrahide hem de cilt/meme başı koruyucu mastektomide güvenle uygulanabilen teknik, genellikle aksiller ve periareolar kombine insizyonlar ile optik görüntüleme sistemlerinin kullanımına dayanır. Ameliyat öncesi ultrason eşliğinde boya veya çizimle lezyon işaretlemesi yapılırken, diseksiyon sürecinde kanamayı ve doku travmasını azaltmak için tumescent (hidrodiseksiyon) tekniği ile yara koruyuculardan faydalanılır. Cerrahi sonrasında oluşan boşluklar hacim kaydırma, doku flebi replasmanı veya sentetik meşlerle doldurulmaktadır. Klasik açık cerrahiyle kıyaslandığında operasyon süreleri ve maliyetleri başlangıçta daha yüksek olsa da, öğrenme eğrisinin tamamlanmasıyla bu süreler eşitlenmektedir. En sık görülen seroma, hematom ve nadiren gelişen meme başı nekrozu gibi komplikasyon oranları ile lokal nüks, uzak metastaz ve genel sağkalım gibi onkolojik sonuçlar açık cerrahiyle benzer düzeylerdedir. Yöntemin en belirgin avantajları minimal skar, üstün kozmetik başarı ve yüksek hasta memnuniyetidir.
Endoscopy-Assisted Oncoplastic Breast Surgery (EAOBS) is a minimally invasive surgical approach developed to optimize aesthetic outcomes in the local treatment of breast cancer. With a history dating back to the late 1990s, this technique has gained widespread acceptance, particularly in Asian countries for T1-T2 tumors in smaller breast volumes. Safely performed in both breast-conserving surgery and skin/nipple-sparing mastectomy, the technique relies on combined axillary and periareolar incisions and optical imaging systems. Preoperative ultrasound-guided dye or drawing localization is performed, and tumescent (hydrodissection) techniques alongside wound protectors are utilized during dissection to reduce bleeding and tissue trauma. Post-surgical defects are managed via volume displacement, autologous flap replacement, or synthetic mesh filling. Although operative times and costs are initially higher compared to conventional open surgery, they equalize once the learning curve is completed. Complication rates, including seroma, hematoma, and occasionally nipple necrosis, as well as oncological outcomes such as local recurrence, distant metastasis, and overall survival, remain similar to open surgery. The most prominent advantages of this method are minimal scarring, superior cosmetic success, and high patient satisfaction.
Referanslar
Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surgery 2014; 3(2): 94-108.
Lee EK, Kook SH, Park YL, et al. Endoscopy assissted breast conserving surgery for early breast cancer. World J Surg 2006; 30: 957-964.
Takahashi H, Fujii T, Nakagawa D, et al. Usefulness od endoscopic breast conserving surgery for breast cancer. Surg Today 2014; 44: 2037-2044.
Saimura M, Mitsuyama D, Anan K, et al. Endoscopy assisted breast conserving surgery for early breast cancer. Asian Endosc Surg 2013; 6: 203-208.
Park HS, Lee JS, Lee JS, et al. The feasibility of endoscopic-assisted breast conservation surgery for patients with early breast cancer. J Breast Cancer 2011; 11(1): 52-57.
Hong YI, Shin H. Endoscopy-assisted breast conserving surgery for breast cancer: A preliminery clinical experience. J Breast Cancer 2010; 13(2):138-146
Tamaki Y, Sakita I, Miyoshi Y, et al. Transareolar endoscopy-assisted partial mastectomy: a preliminary report of six cases. Surg Laparosc Endosc Percutan Tech 2001; 11: 356-362.
Yamashita K, Shimizu K. Endoscopic video-assissted breast surgery: Procedures and short term results. J Nippon Med Sch 2006; 73: 193-202.
Ozaki S, Ohara M, Shigematsu H, et al. Technical feasibility and cosmetic advantage of hybrid endoscopy assisted breast conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A 2013; 23:91-99.
Clough KB, Kaufman GJ, Nos C, et al. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010; 17: 1375-1391.
Nakajima H, Fujiwara I, Mizuta N, et al. Video assisted skin-sparing breast-conserving surgery for breast cancer and immediate reconstruction with autologous tissue. Ann Surg 2009; 249 (1): 91–96.
Serra-Renom JM, Serra-Mestre JM, Martinez L, et al. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back. Aest Plast Surg 2013; 37: 941-949.
Leff DR, Vashist R, Yongue G, et al. Endoscopic breast surgery: where are we now and what might the future hold for video-assisted breast surgery? Breast Cancer Res Treat 2011; 125:607-625.
Fan LJ, Jiang J, Yang XH, et al. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer. Chin Med J (Engl) 2009; 122 (24): 2945–2950.
Sakamoto N, Fukuma E, Higa K, et al. Early results of an endoscopic nipple sparing mastectomy for breast cancer. Ann Surg Oncol 2009; 16: 3406-3413.
Gould DJ, HuntbKK, Liu J, et al. Impact of surgical techniques, biomaterials, and patient variables on rate of nipple necrosis after nippleüsparing mastectomy. Plast Reconstr Surg 2013; 132 (3): 1-14.
Endara M, Chen D, Verma K, et al. Breast reconstruction following nipple sparing mastectomy: A systematic review of the literature with pooled analysis. Plast Reconstr Surg 2013; 132:1043-1054.
Yamashita K, Shimizu K. Transaxillary retromammary route approach of video-assisted breast surgery for breast conserving surgery. Am J Surg 2008; 196:578-581.
Takemoto N, Koyanagi A, Yamamoto H. Comparison between endoscope assissted oartial mastectomy with filling of dead space using absorbabl mesh and conventional method on cosmetic outcome in patients with stage I or II breast cancer. Surg laparos Endosc Percutan Tech 2012; 22: 68-72.
Ho WS, Ying SY, Chan ACW. Endoscopic assissted subcutaneous mastectomy and axillary dissection with immediate mammary prosthesis reconstruction for early breast cancer. Surg Endosc 2002; 16: 302-306.
Owaki T, Yoshinaka H, Ehi K, et al. Endoscopic quadrantectomy for breast cancer with sentinel lymph node navigation via a small axillary incision. Breast 2005; 14 (1): 57–60.
Ito KI, Kanai T, Gomi K, et al. Endoscopic assissted skin sparing mastectomy combined with sentinel node biopsy. ANZ J Surg 2008; 78: 894-898.
Kitamura K, Ishida M, Inoue H, et al. Early results of an endoscope assissted subcutaneous mastectomy and reconstruction for breast cancer. Surgery 2002; 131: 324-329.
Tükenmez M, Ozden BC, Agcaoglu O, et al. Videoendoscopic single port nipple sparing mastectomy and immediate reconstruction. J Laparoendosc & Adv Surg Tech. 2014; 24: 1-6.
Sosin M, Tousimia EA. Commentary on videoendoscopic single port nipple sparing mastectomy and immediate reconstruction. J Laparoendosc & Adv Surg Tech. 2014; 24: 7.
Sanuki J, Fukuma E, Wadamori K, et al. Volume replacement with polyglycolic acid mes for correcting breast deformity after endoscopic conservative surgery. Clinical Breast Cancer 2005; 6 : 175.
Ingram D. Is it time for breast cancer surgeons to embrace endoscopic assisted mastectomy? NZJ Surg 2008; 78 (10): 837–838.
Nakajima H, Fujiwara I, Mizuta N, et al. Video-assisted skin sparing breast conserving surgery for breast cancer and immediate reconstruction with autologous tissue: clinical outcomes. Ann Surg Oncol 2009; 16: 1982-1989.
Sprangers MA, Groenvold M, Arraras JI, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 1996; 14: 2756-2768.
Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 1997; 15: 974-986.
Winchester DP, Cox JD. Standards for breast-conservation treatment. CA Cancer J Clin 1992; 42: 134-162.
Kijima Y, Yoshinaka H, Funasako Y, et al. Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions. Surg Today 2011; 41: 477-489.
Sawai S, Nakajima K, Ichihara S, et al. Cosmetic assessment of the breast after surgery. The 12th Annual Meeting of the Japan Breast Cancer Society 2004; 12: 107–108.
Kitamura K, Hashizume M, Sugimachi K, et al. Early experience of endoscopic extirpation of benign breast tumors via an extra-mammary incision. Am J Surg 1998; 176 (3): 235–238.
Kitamura K, Inoue H, Ishida M, et al. Endoscopic extirpation of benign breast tumors using an extramammary approach. Am J Surg 2001: 181 (3): 211–214.
Behm EC, Beckmann KR, Dahlstrom JE, et al. Surgical margins and risk of locoregional recurrence in invasive breast cancer: an analysis of 10-year data from the Breast Cancer Treatment Quality Assurance Project. Breast 2013; 22: 839-844.
Dick AW, Sorbero MS, Ahrendt GM, et al. Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeons. J Natl Cancer Inst 2011; 103: 92-104.
Gerber B, Krause A, ReimerT, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003; 238: 120–127.
Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now? Surg Oncol.2008; 17: 261–266.
Caruso F, Ferrara M, Castiglione G, et al. Nipple sparing subcutaneous mastectomy: sixty-six months follow-up. Eur J Surg Oncol.2006; 32: 937–940.
Sacchini V, Pinotti JA, Barros AC, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg.2006; 203:704–714.
Voltura AM, Tsangaris TN, Rosson GD, et al. Nipple-sparing mastectomy: critical assessment of 51 procedures and implications for selection criteria. Ann Surg Oncol.2008; 15: 3396–3401.
Petit JY, Veronesi U, Orecchia R, et al. Nipple-sparing mastectomy in association with intraoperative radiotherapy (ELIOT): A new type of mastectomy for breast cancer treatment. Breast Cancer ResTreat. 2006; 96: 47–51.
Psaila A, Pozzi M, Barone Adesi L, et al. Nipple sparing mastectomy with immediate breast reconstruction: a short term analysis of our experience. J Exp Clin Cancer Res.2006; 25: 309–312.
Benediktsson KP, Perbeck L. Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol. 2008; 34: 143–148.
Petit JY, Veronesi U, Rey P, et al. Nipple-sparing mastectomy: risk of nipple-areola rrecurrences in a series of 579 cases. Breast Cancer Res Treat 2009; 114: 97–101.
Crowe JP, Patrick RJ, Yetman RJ, et al. Nipple-sparing mastectomy update: one hundred forty-nine procedures and clinical outcomes. Arch Surg 2008; 143: 1106–1110.
Wijayanayagam A, Kumar AS, Foster RD, et al. Optimizing the total skin-sparing mastectomy. Arch Surg 2008; 143: 38–45.
Stolier AJ, Sullivan SK, Dellacroce FJ. Technical considerations in nipple-sparing mastectomy: 82 consecutive cases without necrosis. Ann Surg Oncol.2008; 15: 1341–1347.
Komorowski AL, Zanini V, Regolo L, et al. Necrotic complications after nipple-and areola-sparing mastectomy. World J Surg. 2006; 30: 1410–1423.
Würinger E, Mader N, Posch E, et al. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg 1998; 101: 1486-1493.
Yamashita K, Shimizu K. Video-assisted breast surgery and sentinel lymph node biopsy guided by three-dimensional computed tomographic lymphography. Surg Endosc 2008; 22 (2): 392–397.
Yamashita K, Shimizu K. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast. Chin Med J (Engl) 2008; 121 (20): 1960.
Tamaki Y, Nakano Y, Sekimoto M, et al. Transaxillary endoscopic partial mastectomy for comparatively early-stage breast cancer. An early experience. Surg Laparosc Endosc 1998; 8(4):308–312.
Nakajima H, Sakaguchi K, Mizuta N, et al. Video-assisted total glandectomy and immediate reconstruction for breast cancer. Biomed Pharmacother 2002; 56(1): 205s–208s.
Curet MJ. Port site metastases. Am J Surg 2004; 187(6): 705–712.
