Comparative outcomes of conventional versus endoscopic-assisted surgery for breast phyllodes tumors: a single center retrospective cohort study

Background: Breast phyllodes tumors (PTs) tend to grow rapidly and often present as large tumors. Consequently, conventional surgery (CS) typically leaves large and conspicuous scars on the breast. In contrast, endoscopic-assisted surgery (EAS) via the axillary approach offers smaller, more concealed incisions, leaving the breast surface unscarred. However, whether this technique can enhance aesthetic outcomes without increasing the risk of PTs recurrence remains unclear. The study aimed to compare the oncologic safety and cosmetic outcomes of EAS versus CS in patients with PTs.

Methods: Patients with newly diagnosed PTs who received surgical treatment were included, and they were stratified into two groups: EAS group and CS group. Propensity score matching (PSM) was used to balance the baseline differences between two groups. Oncologic safety, cosmetic satisfaction, intraoperative indicators, and postoperative complications were compared between patients underwent EAS and CS.

Results: After 1:3 PSM, 200 patients were included in the final analysis (147 CS and 53 EAS). The median follow-up was 23.77 months. EAS was associated with a significantly longer operative time (83.77±26.81 vs. 73.44±34.66 min, P=0.01) but yielded superior cosmetic outcomes, as evidenced by higher BREAST-Q scores for breast satisfaction (76.81±9.15 vs. 69.21±9.64, P<0.001) and psychological well-being (91.16±6.69 vs. 85.17±11.71, P<0.001). Postoperative complications and intraoperative blood loss did not differ significantly. Oncologic outcomes were comparable between the groups, with similar 3-year local recurrence-free survival (LRFS; 97.0% EAS vs. 93.4% CS), distant metastasis-free survival (DMFS; 100% EAS vs. 97.5% CS), and overall survival (OS; 100% EAS vs. 98.3% CS).

Conclusions: In this matched cohort study, EAS approved to be a safe and feasible substitute to CS for PTs, offering equivalent oncologic outcomes while significantly improving cosmetic satisfaction and psychological well-being.