Abstract
Simple SummaryAxillary dissection is a highly mobile procedure with severe lymphatic consequences. The off-label application of fibrin sealants in the axilla, with the sole aim to eliminate dead space and to provoke sealing of the disrupted lymphatic vessels at the end of axillary dissection, is an experimental procedure to reduce lymphatic morbidity. The aim of our systematic review and meta-analysis is to investigate the effects of fibrin sealants on lymphatic morbidity after axillary dissection. Our results show that this experimental procedure is able to decrease the total axillary drainage output, the number of days before the axillary drainage is removed, and the length of hospital stay. However, no effects on the occurrence rate of axillary lymphocele or on the surgical site complications rate were demonstratedBackground: use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy. Methods: randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes. Results: twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin’s disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied (p < 0.0001, p < 0.005, p = 0.008). Conclusion: fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found.
Highlights
Axillary lymph node dissection (ALND) was historically proposed as an integral part of the treatment of breast cancer, melanoma, and Hodgkin’s disease
5 of 15were abstract evaluation because 179 papers did not adopt fibrin sealant devices, 8 papers published as reviews or letters to the editor only, one paper was conducted on patients undergoing pelvic, paraaortic and inguinal lymphadenectomies for gynecological maligOverall, 238 studies were retrieved through the literature search and six additional nancies, and one records paperwere investigated the efficacy of fibrin sealant forwere different identified through reference lists
One study was excluded from the analysis due to its retrospective nature stract evaluation because 179 papers did not adopt fibrin sealant devices, 8 papers were of the selection process, 23/223 (10.3%) screened studies met the inclusion criteria [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]
Summary
Axillary lymph node dissection (ALND) was historically proposed as an integral part of the treatment of breast cancer, melanoma, and Hodgkin’s disease. Full axillary lymph node dissection is restricted to node-positive cases as a therapeutic approach. This procedure can result in significant postoperative complications. Lymphocele is a collection of fluid deriving from the excess lymphatic drainage following the removal of lymph nodes. Lymphoceles can be diagnosed by a clinical examination or by ultrasound This condition may result in pain, repeated aspirations, infections, and could delay local healing and adjuvant treatments. Insertion of suction drains at the time of ALND is the most common surgical method used to reduce lymphocele formation after ALND and subsequent wound complications. Several additional or alternative strategies in the attempt to reduce the rate of lymphoceles and lymphatic complications occurring after a systematic lymphadenectomy were proposed
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