Robotic mastectomy versus open mastectomy in patients with or at high risk of breast cancer: A systematic review and meta-analysis

Objective: This study aimed to compare the efficacy and safety of robotic versus open technique in patients undergoing mastectomy for breast cancer treatment or risk-reduction. Methods: The literature search included English -published studies from inception to the 3rd of February 2023. The search included MEDLINE/PubMed, Cochrane Library, the Web of Science and Scopus, using the terms "robotic mastectomy" AND "open mastectomy". We calculated the odds ratio (OR) with 95% confidence intervals (CI) for categorical outcomes and standardized mean difference (SMD) for numerical outcomes. Results: Five studies were included. Robotic mastectomy was significantly associated with longer operative time (SMD=0.92 (95% CI: 0.34, 1.50), p-value=0.002) and hospital stay (SMD=0.53 (95% CI: 0.03, 1.02), p-value=0.04), but lower rates of overall complications (OR=0.56 (95% CI: 0.42, 0.75), p-value<0.001) and nipple-areola complex necrosis (OR=0.45 (95% CI: 0.24, 0.87), p-value=0.02). There was no significant difference between robotic and open mastectomy in terms of the involvement of surgical margin or locoregional recurrence of breast cancer. Conclusions: Robotic mastectomy can be considered a safe procedure. It may possibly reduce the probability of postoperative complications. The better aesthetic results accomplished with robotic mastectomy enhances the patient satisfaction. Yet, robotic mastectomy can lengthen the total operative time and increase the duration of hospital stay. The included studies showed several limitations, so there is a need to conduct large size, randomised, clinical trials with adequate follow-up before recommending the routine use of the robotic technique for mastectomy.