Robotic surgery for mastectomy and cancer: what the FDA has said
Patients and clinicians often ask whether a surgical robot can be used to remove a breast or treat cancer. The FDA addressed this in a safety communication first issued in 2019 and updated in August 2021.
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Authorization status for cancer uses
The FDA states that it has not granted marketing authorization for any robotically-assisted surgical device for the prevention or treatment of cancer, including breast cancer. The labeling of legally marketed devices says that cancer treatment outcomes with the device have not been evaluated by the FDA.
The FDA has cleared these devices for laparoscopic procedures in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgery, but not for mastectomy.
Why the evidence falls short
FDA reviews have generally focused on whether the complication rate at 30 days is comparable to other techniques. For cancer uses, the FDA expects outcomes such as local recurrence, disease-free survival or overall survival over periods much longer than 30 days.
The communication mentions limited, preliminary evidence that robotic surgery for cancers that mainly or only affect women may be associated with lower long-term survival (other researchers found no statistically significant difference).
Frequently asked questions
What should patients ask their surgeon?
The FDA suggests asking about the surgeon's training, experience and patient outcomes with robotic procedures, how many similar procedures they have performed, and which complications can occur and how often.
How can a complication be reported?
The FDA encourages patients and providers to file a report through MedWatch, its safety information and adverse event reporting program. Staff of facilities subject to user facility reporting should follow their facility's procedures.
Can a clinical study test a new cancer use of a marketed robot?
Yes, but clinical studies in the United States that investigate a new intended use of a legally marketed device are subject to FDA oversight under the Investigational Device Exemption framework.
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