Journal Article

Oncological outcome of endoscopic nipple-sparing mastectomy versus conventional open mastectomy in early breast cancer: a multicenter cohort study

Ye, Xin, Zhu, Yanyan, Ding, Shuning, Wang, Wei, Zhang, Zhaoqi, Zhu, Li, Wang, Qi, Fang, Yan, Wang, Min, Liu, Deyue

2026

Overview

In recent years, endoscopic nipple-sparing mastectomy (ENM) has been applied in breast cancer treatment, whereas conventional open mastectomy (COM) remains widely adopted in clinical practice. The data about the oncological outcomes of ENM vs. COM was rare, especially the multicenter data. This multicenter retrospective cohort study enrolled 2,314 early breast cancer patients diagnosed with stage 0-III, and treated with either ENM or COM from September 1st, 2021 to January 30th, 2025 at three institutions. After exclusions, the final cohort consisted of 1,722 patients, of whom 136 were in the ENM group and 1,586 in the conventional group. Demographic data, clinicopathological features, and oncological outcomes were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias and balance confounders. Before PSM, the patients in ENM group were significant different from COM group in age, menopausal status, hormone receptor status, HER2 status and molecular subtypes. After PSM, the final analysis cohort comprised 136 patients in the ENM group and 408 patients in the COM group. The median follow-up time was 22 months. No significant differences were observed between the two groups in any of the oncological outcome parameters: local recurrence-free survival between COM and ENM groups (97.8% vs. 97.8%; HR, 0.63; 95%CI, 0.14-2.90; P = 0.50); regional recurrence-free survival between COM and ENM groups (98.8% vs. 99.3%; HR, 1.24; 95%CI, 0.17-9.22; P = 0.84); distant metastasis-free survival between COM and ENM groups(97.3% vs. 98.5%; HR, 1.70; 95%CI, 0.47-6.11; P = 0.48); disease free survival between COM and ENM groups(94.9% vs. 96.3%; HR, 1.24; 95%CI, 0.50-3.10; P = 0.66); overall survival between COM and ENM groups(99.3% vs. 99.3%; HR, 0.76; 95%CI, 0.07-8.72; P = 0.81). In this multicenter cohort study, ENM group showed no different oncological outcomes from COM group. ENM could be used as a viable alternative to COM for eligible breast cancer patients.