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Abstract
Introduction: Seroma formation represents one of the most frequent postoperative complications of axillary dissection in breast cancer (BC) patients. We aimed to retrospectively explore the effectiveness of the intraoperative use of a synthetic cyanoacrylate glue (specifically Glubran®2) vs. the intraoperative use of a fibrin sealant (specifically Tisseel) in reducing seroma formation compared to the use of nonsealant in BC patients who underwent breast surgery and axillary dissection.Materials and Methods: We conducted a retrospective, monocentric observational study on BC patients who underwent axillary dissection associated with breast surgery. The axillary dissection was completed with the application of a closed suction drain and was preceded by the application of either Glubran®2 glue or Tisseel sealant or nonsealant. We analyzed the quantity of serum drained in the first 3 postoperative days, length of hospitalization, days of permanence of axillary drain, seroma development, and presence of postoperative infection signs.Results: Forty-one BC patients were considered. Based on the device used during the surgical treatment, the patients were divided into three groups: group A (17 patients), to whom suction axillary drain was applied; group B (7 patients), to whom Tisseel and axillary suction drain were applied; and group C (17 patients), to whom Glubran®2 and axillary suction drain were applied. Among the three groups, we did not find significant differences in terms of amount of serum drained in the first 3 postoperative days, length of hospitalization, and incidence of seroma. Group C maintained the axillary drain in a significantly lower number of days compared to the other two groups (p = 0.02); it also had a lower incidence of postoperative infections (6%) compared to group A (23%) and group B (57%) (p = 0.02).Conclusions: We did not find any evidence that the use of surgical glues may reduce the formation of seroma following axillary dissection in BC patients. Nevertheless, the use of cyanoacrylate glue in association with closed suction axillary drain seems to contribute to the reduction in days of axillary drain permanence and of postoperative infections, which are known factors delaying the schedule of any adjuvant oncological therapies.
Highlights
Seroma formation represents one of the most frequent postoperative complications of axillary dissection in breast cancer (BC) patients
Forty-one Breast cancer (BC) patients who underwent axillary dissection associated with mastectomy or breast conservative surgery were considered
Group A, consisting of 17 patients, to whom axillary closed suction drain had been placed in the axillary fossa;
Summary
Seroma formation represents one of the most frequent postoperative complications of axillary dissection in breast cancer (BC) patients. It has been shown that a frequent complication of these types of treatments is represented by seroma development [4], with a percentage ranging from 15 to 85% [5], together with infection of the surgical site and bleeding Both breast and axillary surgery, due to the dissection of small lymphatic and blood vessels, determine the formation of a highly suitable environment for the collection of fluids, its pathophysiological process is not completely known [6]. The use of fibrin sealant has presented interesting results because of its adhesive and hemostatic properties and in part for its potential biostimulating ability for tissue regeneration [12, 13]; in particular, its combination with “quilting” sutures has been documented to significantly reduce total drainage, hospital stay, and postoperative seroma incidence in patients who underwent postmastectomy breast reconstruction with dorsal muscle flap [14]. The use of a specific type of cyanoacrylate-based synthetic adhesive, Glubran R 2, developed to minimize toxic effect of cyanoacrylate glues, has been described in surgery in substitution or in addition to sutures or staples for its adhesive properties and for the potential activity in decreasing activated partial thromboplastin time, exerting a hemostatic effect and further contributing to tissue adhesion [16,17,18]
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