Axillary Lymphadenectomy For Breast Cancer Research Articles

Seroma control in axillary lymphadenectomy with Glubran 2® without drain. Multicenter, prospective, randomized, clinical trial. GALA-ND study (Glubran, Axillary Lymphadenectomy, Ambulatory, No Drain)

BackgroundSeroma after breast cancer surgery is a frequent entity; therefore, different products have been described in literature with the aim to reduce it. The most studied ones have been the sealants products, being tested with aspirative drains. Symptomatic seroma represents the 19% after axillary lymphadenectomy without drains. The aim of this study is to analyze the effect of a sealant in the seroma control after axillary lymphadenectomy without drains and identify the risk factors related to symptomatic seroma.MethodsThis is a prospective, multicenter, international, and randomized clinical trial. Patients undergoing conservative surgery and axillary lymphadenectomy for breast cancer will be randomized to control group (lymphadenectomy without sealant) or interventional group (lymphadenectomy with sealant Glubran 2®). In any of the study groups, drains are placed. Patients who received neoadjuvant treatment are included. Measurements of the study outcomes will take place at baseline; at 7, 14, and 30 days post-surgery; and at 6–12 months. The primary outcome is symptomatic seroma. Secondary outcomes are seroma volume, morbidity, quality of life, and lymphedema.DiscussionSeveral studies compare the use of sealant products in axillary lymphadenectomy but generally with drains. We would like to demonstrate that patients who underwent axillary lymphadenectomy could benefit from an axillary sealant without drains and reduce axillary discomfort while maintaining a good quality of life. Assessing the relationship between axillary volume, symptoms, and related risk factors can be of great help in the control of seroma in patients who received breast cancer surgery.Trial registrationClinicalTrials.gov, NCT05280353. Registration date 02 August 2022.

Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis

Seroma or lymphocele remains the most common complication after mastectomy and lymphadenectomy for breast cancer. Many different techniques are available to prevent this complication: wound drainage, reduction of the dead space by flap fixation, use of various types of energy, external compression dressings, shoulder immobilization or physical activity, as well as numerous drugs and glues. We searched MEDLINE, clinicaltrials.gov, Cochrane Library, and Web of Science databases for publications addressing the issue of prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy. Quality was assessed using Hawker’s quality assessment tool. Incidence of seroma or lymphocele were collected. Fifteen randomized controlled trials including a total of 1766 patients undergoing radical mastectomy and axillary lymphadenectomy for breast cancer were retrieved. The incidence of lymphocele or seroma in the study population was 24.2% (411/1698): 25.2% (232/920) in the test groups and 23.0% (179/778) in the control groups. Neither modification of surgical technique (RR 0.86; 95% CI [0.72, 1.03]) nor application of a medical treatment (RR 0.96; 95% CI [0.72, 1.29]) was effective in preventing lymphocele. On the contrary, decreasing the drainage time increased the risk of lymphocele (RR 1.88; 95% CI [1.43, 2.48). There was no publication bias but the studies were of medium to low quality. To conclude, despite the heterogeneity of study designs, drainage appears to be the most effective technique, although the overall quality of the data is low.

Nano Carbon Tracing-based Treatment of Breast Cancer Lymphadenectomy and Nursing Intervention of Postoperative Lymphedema.

to investigate the tracing and therapeutic effects of carbon nanoparticles epirubicin (CNP-EPI) on axillary lymphadenectomy for breast cancer and postoperative lymphedema nursing intervention, a total of 60 breast cancer patients in Harbin Medical University Cancer Hospital were selected as the study subjects and randomly divided into group A (n=30) and group B (n=30). They were subcutaneously injected with 1 mL of CNP-EPI 1 day before surgery and 3 days before surgery, respectively, and underwent axillary lymph node dissection. Lymphedema nursing intervention and routine care were implemented in groups A and B, respectively. After adsorption of 2 mL of 6 mg/mL epirubicin by 1 mL carbon nanoparticles, epirubicin could be slowly released with a cumulative release rate of 64.7 %. The black staining rate was 80.2 % (341/425) in group A and 57.7 % (217/376) in group B, and the difference was statistically significant (P < 0.05). The black staining rate in metastatic lymph nodes was 73.1 % (23/52) in group A and 65.9 % (27/41) in group B (P > 0.05). The incidence rate of edema at 1, 3, and 6 months after operation in group A was significantly lower than that in group B (P < 0.05). Carbon nanoparticles have strong adsorption properties and slow drug release ability; subcutaneous injection of CNP-EPI axillary lymph nodes around the areola 1 day before surgery has a better lymphatic tracing effect; lymphedema nursing intervention can effectively reduce the incidence of prognostic lymphedema.

Immediate Lymphatic Reconstruction Drastically Lowers Lymphedema Incidence in Axillary and Inguinal Lymphadenectomy: A Systematic Review

BACKGROUND: Secondary lymphedema remains one of the most notorious complications of axillary lymph node surgery following mastectomy. There is a lack of high-level evidence on the effectiveness of immediate lymphatic reconstruction (ILR) in preventing secondary lymphedema. However, ILR is beginning to be more accepted by plastic surgeons to decrease the incidence of lymphedema. Therefore, lymphedema outcomes from ILR are needed now more than ever. We evaluate ILR outcomes for the prevention of secondary lymphedema in axillary and inguinal lymphadenectomy patients. The purpose of our study was to analyze the outcomes of ILR where the main mechanism was lymphaticovenous anastomosis/bypass. This includes direct shunting of lymphatic fluid to the venous system. Additionally, we provide our own suggestions for this specific mechanism of ILR and what future studies should be done to provide more outcomes to increase the effectiveness of ILR. METHODS: The authors conducted a review of all English language articles between 2009 and 2020 in PubMed, Embase, and Web of Science, reporting original outcomes on different methods of ILR in preventing secondary lymphedema, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Overall incidence timeline of lymphedema in patients postoperatively, postoperation complications, and surgical techniques were recorded and analyzed. We excluded non-ILR interventions, literature reviews/letters/commentaries, and non-human or cadaver studies. Risk of bias was assessed. A total of 789 patients that were enrolled in 13 studies were included in our one-arm meta-analysis. RESULTS: A total of 13 studies encompassing 789 patients met inclusion criteria: upper extremity ILR (n = 665) and lower extremity ILR (n = 124). Females accounted for 99.4% of the patients studied for upper extremity ILR, while men (69.4%) consisted mostly the lower extremity ILR cohort. The overall incidence of lymphedema for upper extremity ILR was 2.7% (95%CI: 1.1%–4.4%, P < 0.001), and lower extremity ILR was 3.6% (95%CI: 0.3%–10.1%, P < 0.001). For upper extremity ILR, the average follow-up time was 11.6 ± 7.8 months and the LE incidence appeared to be the highest around 1–2 years postoperation. ILR procedural time for upper extremity was 45.1 minutes (95%CI: 31.4–58.9 minutes) and lower extremity was 95.1 minutes (95%CI: 75.5–114.7 minutes). Higher incidence of postoperative complications was seen in lower extremity ILR patients (1.6%, 95%CI: 0.1%–4.8%, P < 0.001) than upper extremity ILR patients (0.9%, 95%CI: 0.1%–0.6%, P < 0.001), but neither significantly increased the risk of lymphedema (RR = 0.16, 95%CI: 0.01–4.26, P = 0.20). There was no correlation of lymphedema incidence rate with BMI (r = 0.115, P = 0.73), additional time added to a procedure (r = 0.159, P = 0.73), number of lymph nodes identified (r = −0.194, P = 0.54), and number of lymph nodes removed (r = 0.080, P = 0.80) CONCLUSIONS: Lymphedema is a common complication in cancer treatment that needs to be taken seriously. Immediate Lymphatic Reconstruction is an effective technique to restore lymphatic drainage at the time of the index procedure for both upper and lower extremities and will decrease the incidence of lymphedema. Plastic surgeons who perform axillary lymphadenectomy for breast cancer or inguinal lymphadenectomy for malignant melanoma or for vulvar cancer may increase a patient’s risk of lymphedema postoperation and should consider ILR to reduce this risk.

Fibrin Sealants and Axillary Lymphatic Morbidity: A Systematic Review and Meta-Analysis of 23 Clinical Randomized Trials.

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.

Axillary node dissection in outpatient procedure, is it feasible and safe?

BackgroundOutpatient procedure in cancer surgery is one of the tracks to guarantee the quality of care respecting the delay of support.The aim of this study was to assess the feasibility and safety of outpatients with axillary lymphadenectomy and the postoperative morbidity after outpatient’s procedures compared to patients with classic hospitalization. MethodsPatients who underwent axillary lymphadenectomy for breast cancer or melanoma were analyzed.We selected patients having axillary lymphadenectomy only or associated with another operative act compatible with outpatient’s procedure (partial mastectomy, lumpectomy or skin excisions). ResultsThree hundred and forty-nine patients were included. Outpatient procedures were performed in 142 patients (40.7%) and inpatient procedures were performed in 207 patients (59.3%).All time complications combined, we found 148 patients with at least one complication: 77 patients (52.0%) and 71 patients (48.0%) in outpatient and inpatient group, respectively (p=0.0002). The main complication was seroma formation, it concerned 104 patients Among them, Seroma formation was more frequent in ambulatory group, 60 patients (57.7%) and 44 patients (42.3%) in traditional hospitalization (p<0.0001) but 58.7% (61/104) needed only one aspiration and all complications were managed in outpatient. ConclusionComplications (mostly seroma) appeared usually after hospitalization discharge and they were known and simple to take in charge. A precise preoperative information concerning post-operative morbidity, specially seroma allows a better comprehension and acceptation of this side effect. We believe that this surgery is feasible and safe in outpatient procedure.

Abstract 65: Immediate Lymphatic Reconstruction After Axillary Lymphadenectomy Makes A Difference: A Two Year Comparative Analysis

Purpose: Axillary lymph node dissection (ALND) in the treatment of breast cancer increases the risk of iatrogenic lymphedema. Current rates after ALND range from 11-30%. We hypothesize that our lymphedema prevention surgical (LPS) paradigm, ALND with axillary reverse mapping (ARM) and lymphatico-venous bypass (LVB), lowers the risk of lymphedema. Here, we present findings from a case control study from patients undergoing this procedure. Methods: A review of our prospectively maintained lymphedema surgical registry was performed. Ninety-six consecutive patients with complete ALND underwent LPS at our institution from 9/2016-10/2019. A control group was selected consisting of 92 patients who underwent ALND without LPS in a concurrent time interval from 9/2016-11/2017 to prevent surgical technique or learning curve bias. Patients were followed for both signs and symptoms of lymphedema throughout the post treatment interval and underwent serial assessments for lymphedema via standardized arm circumference measurements by a certified lymphedema therapist. Lymphedema was defined as more than a 10% difference in volume between upper limbs in conjunction with characteristic symptoms and signs. Demographic, procedural and oncologic data was compared between groups. Results: Lymphedema occurrence rates were significantly different between control and treatment groups during the followup period (16.3% non-LPS vs. 5.3% LPS, p=0.006). Of the 15 non-LPS patients who developed lymphedema, 14 received PMRT and 5 had neoadjuvant chemotherapy. Five LPS patients acquired lymphedema, two had PMRT and all five underwent neoadjuvant chemotherapy. Clinical staging differed with a higher proportion of advanced nodal stage in LPS patient group. The mean lymph nodes removed per case was slightly higher in the LPS group (14.4 vs. 11.2). Rates of post mastectomy radiation therapy (PMRT) were similar (77% to 89%, respectively), but neoadjuvant chemotherapy rates were lower in non-LPS patients (43% vs 74%). The follow-up time was 15.3 months for the LPS group and 31.3 months for the non-LPS group. Following reverse mapping in LPS, an average of 2.1 blue transected lymphatics were identified per case. An average of 0.1 blue lymphatic vessels was left in continuity per case and 1.6 vessel anastomoses performed per case with intussusception being performed more frequently than end to end technique (55% vs 44%). Conclusion: In one of the largest controlled studies in this topic to date, our findings support that optimizing lymphatic preservation and restoring antegrade lymphatic flow with LPS significantly decreases short term lymphedema rates in patients undergoing axillary lymphadenectomy for breast cancer.

Use of Low-Thrombin Fibrin Sealant Glue After Axillary Lymphadenectomy for Breast Cancer to Reduce Hospital Length and Seroma

BackgroundAxillary lymphadenectomy for primary breast cancer produces a non-negligible rate of postoperative lymphorrhea, prolonged hospital stays, and multiple seroma punctures. We evaluated the impact of low-thrombin fibrin sealant glue on surgical wounds in patients undergoing axillary lymph node dissection for breast cancer. MethodsWe conducted an observational study of 149 patients who underwent axillary lymphadenectomy for primary breast cancer between January 2014 and December 2015. Data were obtained from 2 successive prospective studies. The hospital stay length and morbidity (seromas, punctures) were compared between 2 groups: patients who had padding sutures and low-thrombin fibrin sealant glue without drainage (n = 49) and patients with drainage alone (n = 100). Hospital costs were assessed from the hospital perspective. ResultsThe mean hospital stay length was shorter in the fibrin sealant group (2.6 vs. 4.7 days; P < .001). Seroma magnitude and punctures were similar in patients treated with fibrin sealant compared with patients with drainage alone. The rate of needle aspiration for seroma was similar irrespective of whether or not a drain or fibrin sealant was used (30.6% vs. 33.0%, P = .77). ConclusionLow-thrombin fibrin sealant glue does not significantly reduce the amount of fluid produced in the axilla after breast surgery; however, its systematic use may help reduce hospital stays and costs.

Interneural tissue clearance in axillary dissection for breast cancer: What is the importance?

Breast cancer is the most common cancer in women and second most common type of cancer overall. The prime objectives of axillary surgery in the management of breast cancer are 1) accurate staging, 2) treatment to cure and 3) quantitative information of metastatic lymph nodes for prognostic purposes and allocation to adjuvant protocols. During axillary dissection, all 3 level lymphnodes are removed, while the important axillary structures (axillary vein, long thoracic and thoracodorsal nerves) are preserved. The latter two structures are particularly vulnerable to injury when dissecting the tissue between them (the interneural tissue). This prospective non-randomized study, conducted on 125 female patients, who underwent axillary lymphadenectomy for breast cancer has evaluated the importance of dissection of the Interneural tissue during axillary dissection in breast cancer surgery by reviewing the lymph node yield and metastasis rate. The interneural tissue was excised separately after a routine axillary dissection. Lymph nodes were found in the interneural tissue of 70 out of 125 patients (56%). The average number of interneural lymph nodes recovered per specimen was 1.3. The interneural tissue lymph nodes were positive for metastasis in 10 (8%) patients. There was no incidence of isolated metastasis in the internerve tissue nodes. There is a significant incidence of lymph nodes (56%) and axillary node metastases (8%) in the tissue lying between the long thoracic and thoracodorsal nerves. Therefore, meticulous dissection and excision of this interneural tissue is strongly recommended to optimize decision making regarding adjuvant treatment and outcome.

Progetto educativo per la prevenzione linfedema secondario nelle pazienti con carcinoma mammario: studio di coorte

Introduction: Secondary lymphoedema represents a potential complication of axillary lymphadenectomy for breast cancer. lymphoedema related to breast cancer, requires targeted interventions based on the best scientific evidence in order to motivate patients to observe behaviour that will reduce the risk. The aim of the study is to structure an educational intervention and evaluate the knowledge of patients who have undergone lymph node removal in the prevention of lymphoedema. Materials and methods: Prospective cohort study, conducted between May and August 2014 on patients undergoing axillary lymphadenectomy for breast cancer. The patients were divided into three cohorts, the first group received the educational intervention, the second group received routine information while the third group consisted of patients being treated for lymphoedema. Results: the sample consists of 45 patients, 57.8% of the sample knew the preventive measures for lymphoedema, 13.3% of patients did not receive any information, more than 20% of the sample identifies the nurse as the main source of information. Discussion: The group of patients given the educational intervention, started preoperatively, have more knowledge about prevention, are more aware of the risks compared with the group that received the routine information while patients treated for lymphoedema have good knowledge. Conclusion: Patient management capacity improves significantly as the level of information received increases. The educational intervention begins in the perioperative phase, nurses must favour the process of self-care of the patients by improving their knowledge and skills in the prevention of lymphoedema.

Effectiveness of an absorbable fibrin sealant patch to reduce lymphoceles formation after axillary lymphadenectomy for breast cancer: a matched-pair analysis

BackgroundThis study evaluated the use of TachoSil as an adjunctive therapy for reducing axillary lymphocele formation. MethodsEighty-six patients diagnosed with breast cancer N+ and treated with axillary lymphadenectomy received a TachoSil patch in the axillary wound. Using a database of patients without placing a hemostatic patch, we applied a matched case–control in a 1-to-2 fashion. Multiple and logistic regression analyses were used to evaluate postoperative results. ResultsPatient group with TachoSil showed a significantly lower drainage volume (P < .001) and the length of stay was significantly shorter (P < .001). The number of patients with evacuative punctures was 24.5% in the group with patch versus 51.2% in the control group (P < .001). In multivariate analysis, the use of TachoSil was a significant predictor of reducing axillary drainage volume (P < .001), mean length of hospital stay (P = .001), and number of evacuative punctures of lymphocele (odds ratio .264, 95% confidence interval .144 to .484, P < .001). ConclusionThe use of TachoSil in axillary lymphadenectomy may be a safe and useful treatment option for reducing axillary drainage volume, incidence of symptomatic lymphocele, and hospital stay.

Axillary lymphadenectomy for breast cancer in elderly patients and fibrin glue.

BackgroundAxillary lymphadenectomy or sentinel biopsy is integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial results.MethodsThirty patients over 60 years underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 15 patients; the other 15 patients were treated with harmonic scalpel.ResultsSuction drainage was removed between post-operative Days 3 and 4. Seroma magnitude and duration were not significant in patients receiving fibrin glue compared with the harmonic scalpel group.ConclusionsUse of fibrin glue does not always prevent seroma formation, but can reduce seroma magnitude, duration and necessary evacuative punctures.

Effectiveness of OK-432 (Sapylin) to Reduce Seroma Formation After Axillary Lymphadenectomy for Breast Cancer

The occurrence of seroma formation after axillary lymphadenectomy for breast cancer cannot be ignored. Various approaches have been used in an effort to reduce it, but these results are still controversial. We aimed to describe a new method of application of OK-432 (Sapylin, heat-treated Su strain of Streptococcus) to reduce seroma formation after axillary lymphadenectomy for breast cancer and to verify the safety and efficacy of it as a beneficial supplement for conventional surgery. A prospective, randomized analysis of consecutive quadrantectomy or mastectomy plus axillary lymphadenectomy using or not using OK-432 was designed. From July 2010 to November 2011, a total of 111 patients were enrolled in this prospective, randomized study and completed the follow-up. OK-432 applied to the axillary fossa plus placement of closed suction drainage was used in 54 patients (the experimental group); placement of closed suction drainage was used in 57 patients (the control group). There were no statistical significance between the two groups in terms of age, body mass index, treatment received, tumor size, number of removed lymph nodes, and lymph node status. Postoperative drainage magnitude and duration were significantly reduced in the experimental group (P = 0.008 and 0.003, respectively). One week after hospital discharge, fewer patients developed a palpable seroma in the experimental group: 10 in the experimental group versus 28 in the control group (P = 0.001). Fewer seromas needed aspiration (mean 1 [range 0-3] in the experimental group vs. mean 4 [range 1-5] in the control group; P < 0.001). There were no significant differences in terms of the incidence of complications associated with axillary lymphadenectomy (P = 0.941). OK-432 is a feasible and safe option for axillary lymphadenectomy for breast cancer. The use of it does not always prevent seroma formation, but it can reduce drainage magnitude and duration, as well as decrease the incidence of seroma after the removal of drainage. It may be increasingly conducted in day surgery clinics.

Axillary lymphadenectomy for breast cancer. A randomized controlled trial comparing a bipolar vessel sealing system to the conventional technique

AimTo compare safety and efficacy of a bipolar vessel sealing system (BVSS) to the conventional technique in axillary node dissection. Methods116 women with breast cancer were randomized to conventional node dissection surgical technique (control; n = 58) by scalpel and monopolar cautery or using an electrothermal BVSS (study group; n = 58). ResultsThe median (range) total volume of fluid collected by drain and aspirations was 305 (30–1420) mL in the study group and 335 (80–1070) mL in the control group (p = 0.325). The median (range) total volume of lymph collected by percutaneous aspirations was 207.5 (40–1050) mL in the study group and 505 (270–705) mL in the control group (p = 0.010). The incidence of seroma was similar in both groups (p = 0.845). The axillary drain was removed earlier in the study group than in controls (p = 0.046). ConclusionThe use of a BVSS offers marginal advantages when compared to the conventional technique.

A Case of Long Term Survival in Woman with Metastatic Breast Cancer Treated with Trastuzumab

SUMMARY: Intravenous Trastuzumab is an effective treatment for metastatic breast cancer after failure of first- line chemotherapy for patients with human epidermal growth factor 2 (HER- 2) - positive receptor. The aim of this study is to present of case of long time survival woman with metastatic breast cancer. The case is a 55- years old female. She underwent left mastectomy with axillary lymphadenectomy for breast cancer. Histological examination showed invasive ductal carcinoma, grade III, estrogen and progesterone receptor- negative, HER2positive receptor status. Radiotherapy and six courses with antracyclines were performed as adjuvant chemotherapy. One year after the operation she was diagnosed to have lung metastases. Treatment was initiated with Trastuzumab 8 mg/kg for loading dose and 4 mg/kg maintenance dose every week. Treatment was continued for more than two years. Control computer tomography indicates stable disease. No adverse events were reported for twenty four months of Trastuzumab treatment. Treatment was stopped due to patients withdrawn. Overall survival was 31 months. This case indicate that long term Trastuzumab would be an optimal treatment for HER2- positive breast cancer patients.

Does the use of fibrin glue prevent seroma formation after axillary lymphadenectomy for breast cancer? A prospective randomized trial in 159 patients

Seroma formation frequently occurs in patients who have undergone axillary lymphadenectomy. The aim of the study was to evaluate the effect of fibrin glue in the prevention of seroma formation after axillary lymphadenectomy. Hundred fifty-nine breast cancer patients about to undergo quadrantectomy or mastectomy plus axillary lymphadenectomy were enrolled in the study and randomized into two groups. Fibrin glue spray applied to the axillary fossa plus placement of closed suction drainage were used in 80 patients (group A); placement of closed suction drainage was only used in 79 patients (group B). Group A patients showed a slight advantage with regard to the mean duration of axillary drainage placement (4.5 +/- 1.3 days in group A vs. 5.1 +/- 1.6 days in group B) and number of seroma aspirations (6.3 +/- 1.1 in group A vs. 6.7 +/- 1.2 in group B). No statistically significant differences were observed between the two groups of patients regarding the mean volume of total axillary drainage and of total seroma volume. The use of fibrin glue does not prevent seroma formation and does not reduce seroma magnitude and duration. The costs of the product involved do not justify its routine use in patients undergoing axillary dissection.

267 Seroma following axillary lymphadenectomy for breast cancer

267 Seroma following axillary lymphadenectomy for breast cancer

Effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer

Background Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15% to 85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results. Methods Fifty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray and a collagen patch were applied to the axillary fossa in 25 patients; the other 25 patients were treated conventionally. Results Suction drainage was removed between postoperative days 3 and 4. Seroma magnitude and duration were significantly reduced ( P = .004 and .02, respectively) and there were fewer evacuative punctures in patients receiving fibrin glue and collagen patches compared with the conventional treatment group. Conclusions Use of fibrin glue with collagen patches does not always prevent seroma formation, but it does reduce seroma magnitude and duration, as well as necessary evacuative punctures.

Invited commentary on effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer

Invited commentary on effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer

Randomized clinical trial comparing axillary padding with closed suction drainage for the axillary wound after lymphadenectomy for breast cancer

After axillary lymphadenectomy for breast cancer, a suction drain is routinely inserted into the axilla to prevent seroma formation. This drain is an obstacle to reducing hospital stay after breast-conserving surgery. This was a prospective randomized clinical trial to assess the safety and results of axillary padding without the use of a drain. Between May 2001 and August 2003, 100 women were randomly allocated axillary padding without a drain or with the use of an axillary suction drain. Prospective assessments were made of morbidity, pain, shoulder mobility, quality of life and medical costs including length of hospital stay. Using axillary padding significantly reduced the mean (s.d.) length of hospital stay (1.8(1) versus 4.5(2) days, P < 0.001). Postoperative complications, pain, shoulder mobility and quality of life were similar in the two groups. There was no difference in the duration of the two procedures. Axillary padding after axillary lymphadenectomy was feasible and safe, without a drain, and shortened hospital stay.