By Dr Mandeep Singh Malhotra
Cancer ranks as the second leading global cause of death, with one in six lives affected, according to the World Health Organization. In India, breast cancer, constituting 14 per cent of female cancers, poses a significant challenge. For every two women diagnosed, one sadly succumbs to the disease. In 2020, 178,361 new cases were reported, with urban women facing a higher risk (1 in 22) than rural women (1 in 60). A 66 per cent five-year survival rate emphasizes the need for improved early detection and accessible treatment. Late-stage diagnoses often result in a 50-60 per cent mastectomy (breast-removal) rate. Factors such as urbanization, lifestyles, and limited awareness contribute to rising cases. At present there is a rise in patients presenting to us at early stages and those in advanced stages are experiencing good response after being treated with systemic therapy comprising of chemotherapy, immunotherapy/targeted therapy. These patients are candidates for more precise surgery in the form of Oncoplastic Breast Preservation Procedures rather than radical mastectomies. Robotic assistance adds further precision with improvement in aesthetics as well.
Robotic surgery
Amidst the challenges, robotic surgery offers a ray of hope for effective and precise breast cancer surgery as well as breast preservation. Robotic surgery, a revolutionary approach, offers a more precise and less morbid alternative for both resection and reconstruction. This minimally invasive technique boasts of numerous advantages over traditional open surgery, including greater precision and control, smaller incisions, reduced blood loss, and shorter recovery times.
Robotic surgery as a solution
Traditionally, breast cancer surgery has involved modified radical mastectomies or radical mastectomies. However, these procedures are now only indicated for advanced cancers that do not respond to systemic therapy. Oncoplastic breast preservation has become the standard of care. For early-stage cancers not involving skin/nipple and those patients who have had good responses to systemic therapy, skin-sparing and nipple-sparing (SSM/NSM) resections are offered. Robotic assistance in SSM/NSM resections provides several advantages such as superior access, as robotic arms provide better access to angles that are difficult to reach with retractors in open surgery. The magnified 3D view and resolution provided by robotic assistance allow for more precise dissection. Incisions are typically placed in skin creases, such as the axillary (lateral) or inferior mammary creases. This results in superior aesthetics compared to conventional skin-sparing procedures. In addition to this, minimized counter traction and careful incision planning help preserve skin flap vascularity.
Robotic assistance also simplifies breast reconstruction procedures, particularly those involving latissimus tissue (LD) flaps from the back. Traditionally, harvesting the LD flap requires a long incision in the back, patient repositioning, and re-draping. Robotic assistance eliminates the need for these steps by providing access to the back through the axilla, avoiding the back incision and scar. The advantages of robotic assistance in breast surgery include reduced surgical time by half and elimination of the need for a long incision in the back.
Transformation through robotic assistance
In India, where breast cancer remains a prevalent health concern, robotic-assisted surgery is emerging as a transformative tool for its treatment. With the urgency of innovative solutions highlighted by staggering statistics, the benefits of robotic surgery for oncoplastic procedures and breast reconstruction mark a significant step forward in improving patient outcomes, reducing invasiveness, and enhancing overall experiences. As technology advances and access to such sophisticated methods expands, the prospect of a future where breast cancer is more manageable, effectively treated, and with greater precision is becoming increasingly realizable.
Robotic surgery is poised to revolutionize breast cancer treatment in India, offering not just hope but substantial progress toward better lives for those affected by this relentless disease. As the nation grapples with the escalating burden of cancer, the transformative impact of robotic surgery provides a glimpse into a future where precision, efficiency, and improved outcomes redefine the landscape of breast cancer treatment.
Dr Mandeep Singh Malhotra, Director of Surgical Oncology at CK Birla Hospital, Delhi
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