Robot-Assisted Versus Open Surgery in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis

Breast cancer is the most frequently diagnosed malignancy among women and remains a leading cause of cancer-related mortality. Nipple-sparing mastectomy (NSM), especially when combined with immediate reconstruction, has demonstrated oncologic safety and improved aesthetic outcomes. Robotic-assisted NSM (R-NSM) is a recent advancement offering better visualization and minimally invasive benefits, though its long-term safety and effectiveness remain under evaluation.

Databases searched included PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies compared R-NSM with open NSM for early-stage breast cancer and reported surgical or oncologic outcomes.

Eight studies including 1743 patients were included in the meta-analysis. R-NSM was associated with a significantly longer operative time (mean difference: 47.95 minutes; 95% CI, 13.89-82.02) but significantly lower intraoperative blood loss (mean difference: -34.29 mL; 95% CI, -43.63 to -24.95). Major complication risk was also lower (RR: 0.45; 95% CI, 0.23-0.86). Nipple-areola complex necrosis was significantly lower in R-NSM (RR: 0.55; 95% CI, 0.35-0.88). No significant differences were observed for skin necrosis, seroma, or surgical site infections. Heterogeneity was high in several outcomes.

R-NSM may improve perioperative outcomes by enabling precise dissection through remote incisions, potentially preserving vascular supply to the nipple-areola complex and reducing severe complications. The trade-off is longer operative time, largely due to robotic system setup and surgeons experience.

Robotic-assisted NSM reduces blood loss and major complication at the cost of longer operative times. Further high-quality studies are needed to confirm its long-term oncologic outcomes and guide patient selection.