Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

Abstract

OBJECTIVE:This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection.METHODS:The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552.RESULTS:The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 – 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups.CONCLUSION:Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial

“…Use of drainage for seroma prevention has been contentious for long. Several RCTs and meta-analyses have shown that no drainage or early drain removal following ALND is safe, with no difference in infection rates; however, the incidence of seroma is significantly requiring longer hospital stay or a more demanding outpatient care [2,[12][13][14][15]. Most patients prefer to stay in hospital until their drains are removed [16].…”

Suction Drain Volume following Axillary Lymph Node Dissection for Melanoma—When to Remove Drains? A Retrospective Cohort Study

“…Most authors remove the drains early on the first day after surgery if the drainage volume is ≤50 mL per 24 h or the day after without regard to the drainage volume [22,23]. If the drain is removed on a later day, the drainage volume is not considered as a factor regarding the removal [24,25]. Additionally, all of our melanoma patients had a positive sentinel node, meaning they already had one axillary surgery, whereas with breast cancer, most often only a needle biopsy of a pathological lymph node is performed prior to ALND.…”

Retrospektive 4-Jahres-Analyse geschlossener Drainagesysteme an einem dermatochirurgischen Zentrum – Notwendigkeit einer individualisierten Anwendung

“…Aus der Gynäkologie kommen evidenzbasierte Daten zur Verwendung von Drainagen nach kompletter axillärer Lymphknotendissektion: Die Arbeitsgruppe um Freitas-Junior R et al konnte aktuell zeigen, dass die Raten an Infektionen, Nekrosen und Hämatomen zwischen Patienten, die im Rahmen der operativen Versorgung von Mammakarzinomen mit kompletter axillärer Lymphknotendissektion Drainagen erhielten, gleich waren im Vergleich zu Patientinnen, die keine Drainage erhielten [16]. Zu einem ähnlichen Ergebnis kommt eine Cochrane-Analyse aus dem Jahr 2013: trotz qualitativ schwacher Hinweise auf eine Reduktion von Seromen und reduzierter Notwendigkeit postoperativer Serom-Aspirationen, müssen die Nachteile einer Drainage (möglicherweise verlängerte Hospitalisierung) sorgfältig abgewogen werden [17].…”