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

Abstract

Background: 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.

A comparative high‐resolution physicochemical analysis of commercially available fibrin sealants: Impact of sealant osmolality on biological performance

“…Fibrin sealants are among the most prevalent technologies in the surgical toolbox, and, after more than a century of research, it is becoming increasingly clear that there is no universal sealant composition that matches all criteria relating to hemostatic or sealing efficacy, adequate adhesion, biosafety, cost effectiveness and ease of application. This is also reflected by recent meta‐analyses showing that positive effects of fibrin sealants on patient outcomes vary considerably depending on the fibrin sealant system used and the surgical setting 22,58–60 . Previous studies have focused on the clinical evaluation of fibrin sealants versus other natural or synthetic sealant systems, while comparative data, both clinical and non‐clinical, on individual products within the fibrin sealant class are still scarce.…”

“…This is also reflected by recent meta‐analyses showing that positive effects of fibrin sealants on patient outcomes vary considerably depending on the fibrin sealant system used and the surgical setting. 22 , 58 , 59 , 60 Previous studies have focused on the clinical evaluation of fibrin sealants versus other natural or synthetic sealant systems, while comparative data, both clinical and non‐clinical, on individual products within the fibrin sealant class are still scarce. We thus sought to analyze in detail the overall physicochemical properties of two fibrin sealants, FS and FS+Osm, which have both been successfully used in clinics.…”

Effectiveness of fibrin sealants in head and neck surgery: a systematic review protocol

“…In a meta-analysis of axillary lymphadenectomy patients, fibrin sealants reduced drainage output, days with drainage, and hospital stay. 14 Some studies on fibrin sealant use in hernia repairs showed a lower risk of postoperative complications, reduced postoperative recovery times, and reduced incidence of postoperative and chronic pain. 15 Another meta-analysis of fibrin sealants in bariatric surgery reported a significantly reduced incidence of bleeding (Risk ratio [RR] 0.42, 95% CI 0.18-0.97) compared with controls.…”

“…Some studies have shown fibrin sealants reduce surgical drain retention time, drain volume output, hospital length of stay, postoperative pain, and hematoma or seroma formation. In a meta-analysis of axillary lymphadenectomy patients, fibrin sealants reduced drainage output, days with drainage, and hospital stay 14 . Some studies on fibrin sealant use in hernia repairs showed a lower risk of postoperative complications, reduced postoperative recovery times, and reduced incidence of postoperative and chronic pain 15 .…”