Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute, shared on LinkedIn:
“Endoscopic BCS beats open surgery on scars – but read the fine print
A new phase III RCT (‘The Breast’, 163 patients, 3 Chinese centres) shows single-axillary-incision endoscopic BCS (M-E-BCS) outperforms conventional open BCS on 18-month SCAR-Q (79.9 vs 61.4, P<0.001) and BREAST-Q satisfaction, with similar operative time and complications.
Direction is plausible – a hidden axillary scar should beat visible dual incisions. But the magnitude deserves scrutiny:
- Unblinded PROs. Open-label – patients knew which technique they got before rating scar satisfaction. Novelty/expectation effects aren’t separable from true anatomic difference.
- Ueda score is structurally unblindable. Scored from photographs where scar pattern ‘is’ the allocation marker – single axillary scar vs. breast-surface scarring in >80% of controls. No kappa reported.
- Comparator fidelity. All three surgeons are the technique’s inventors, publishing their own prior work on it. The “conventional” arm may not reflect best-available open oncoplastic technique – classic allegiance-effect risk.
- Single-ethnicity cohort. All-China population; scar/aesthetic satisfaction varies by skin type and cultural expectation. Generalisability beyond this population is unproven.
- Narrow tumour location. 93.3% inner/outer region only; authors themselves don’t recommend M-E-BCS for lower-region tumours. Conclusions apply to a subset, not BCS broadly.
Likely a real scarring benefit – but independent replication with blinded/kappa-tested assessors, non-inventor surgical teams, and diverse populations is needed before this changes standard practice.”
Title: Minimal incision-assisted endoscopic versus conventional open breast-conserving surgery: A multicentre randomized clinical trial
Authors: Mengxue Qiu, Hui Dai, Tao Zhu, Faqing Liang, Yu Feng, Yanyan Xie, Hao Wu, Guilin Luo, Zhengyi Liu, Donglin Zhang, Yang Yue, Zhenggui Du
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