Collagen sealant patch to reduce lymphatic drainage after lymph node dissection

Abstract

BackgroundSeroma formation is a frequent complication following radical lymph node dissection (RLND) in patients with metastatic melanoma. Several strategies have been used to prevent fluid accumulation and thereby reduce the duration of postoperative drainage, including fibrin sealants.MethodsThis was a prospective, single-center study in which consecutive patients undergoing surgical treatment of stage III metastatic melanoma by axillary or ilio-inguinal RLND were randomized to receive standard treatment plus fibrinogen/thrombin-coated collagen sealant patch (CSP) or standard treatment alone. The primary endpoint of the study was postoperative duration of drainage.ResultsA total of 70 patients underwent axillary (n = 47) or ilio-inguinal (n = 23) RLND and received CSP plus standard treatment (n = 37) or standard treatment alone (n = 33). Mean duration of drainage was significantly reduced in the CSP group compared with standard treatment (ITT analysis: 20.1 ± 5.1 versus 23.3 ± 5.1 days; p = 0.010). The percentage of patients drainage-free on day 21 was significantly higher in the CSP group compared with the standard treatment group (86% versus 67%; p = 0.049).ConclusionsUse of the tissue sealant resulted in a significant reduction in duration of drainage. Further studies are warranted to confirm these results in different and selected types of lymphadenectomy.

The use of Tisseel™ fibrin sealant in selective neck dissection – a retrospective study in a tertiary Head and Neck Surgery centre

“…However, two randomised trials that investigated the use of fibrin sealant in tumour excision and axillary dissection for breast cancer in a total of 190 patients demonstrated a benefit in terms of drain output from the use of fibrin sealant . Di Monta and colleagues showed that the use of fibrin glue in a group of 70 patients undergoing radical lymph node dissection for stage III metastatic melanoma resulted in a significant reduction in duration of drainage …”

Video Endoscopic Inguinal Lymphadenectomy: Refi ning surgical technique after ten years experience

“…Reduction of lymphatic events was not demonstrated in this preliminary reports due to the small number of related events which are probably explained by the relatively low practice and the indiscriminate use of energy to seal lymphatic vessels [8][9][10][11][12][13]. To improve this aspect, we indicate to increase the use of clipping to control small vessels, visualized by laparoscopic magnifi ed vision.…”

“…To improve this aspect, we indicate to increase the use of clipping to control small vessels, visualized by laparoscopic magnifi ed vision. As an adjuvant maneuver, biological glue can be used to reduce lymphatic drainage, as demonstrated in other studies of groin dissection [9][10][11][12][13].…”

“…Inguinal nodal involvement is found in 20% to 40% of cases at diagnosis and nodal metastasis is an important predictive factor for survival [2,3]. Metastatic penile carcinoma has an extremely poor prognosis, since reported results of systemic therapy have been disappointing, even when improvement is achieved [4][5][6][7][8][9][10][11][12].…”

Ultrasonic Shears Versus Electrocautery in Axillary Dissection for Breast Cancer—A Randomized Controlled Trial

“…These include closure of dead space [8,9], use of thrombin [10], compression dressings [11,12] aspiration alone instead of drainage [13], use of collagen tissue sealants [14,15], and delaying postoperative shoulder exercises [16]. Use of ultrasonic shears for breast cancer surgery has been described as early as 2000 by Deo et al [17], in which they showed the feasibility of modified radical mastectomy using ultrasonic shears.…”