Current practices and challenges of endoscopic-assisted breast surgery in China: A nationwide cross-sectional survey

Introduction: Endoscopy-assisted breast surgery is gaining popularity in the treatment of breast cancer owing to its minimally access nature. However, its application in Mainland China varies significantly across regions. We aimed to evaluate the current practices and challenges of endoscopy-assisted breast surgery in Mainland China using a nationwide cross-sectional survey. Material and methods: In 2022, we conducted a comprehensive questionnaire survey across Mainland China regarding the clinical practices of breast surgery in 215 hospitals, 198 responded fully before September 2024 and included for analysis. Data on hospital characteristics, types of EABS performed, agreements on indications and contraindications, complications, and surgeon preferences were collected and analyzed. Results: Of 198 hospitals with complete responses in the endoscopy-assisted breast surgery section, 93 (47.0 %) could perform endoscopy-assisted breast surgery, and 7 (3.5 %) could perform robot-assisted breast surgeries. Hospitals performing endoscopy-assisted breast surgery had more developed breast surgery departments, higher numbers of inpatient beds, and a greater patient population. The median annual number of endoscopy-assisted breast surgery procedures per hospital was 55, with significant variability. Common procedures included endoscopy-assisted breast-conserving surgery and lumpectomy (15.5 % and 30.7 %, respectively). Breast reconstructions constituted 15.5 %. The most commonly reported complications were seroma formation and bleeding. Despite these complications, endoscopy-assisted breast surgery was considered safe and effective, with positive aesthetic and functional outcomes. Conclusions: To the best of our knowledge, this is the largest cross-sectional study on endoscopy-assisted breast surgery-related clinical practices in China, highlighting regional disparities and the need for standardized training and procedures.