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

Abstract

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.

Exploration of wound‐related complications post‐kidney transplantation

“…Nonetheless, it is crucial to maintain vigilant surveillance despite the lack of recurrence; scholarly works do document occurrences in which these complications resurface, especially in situations where initial management was inadequate. 40,41 Following kidney transplantation, our study concludes with significant findings regarding the management of wound-related complications, their prevalence and risk factors. It emphasizes the significance of comorbidities and patient characteristics, such as age, in determining postoperative outcomes.…”

“…In cases of lymphocoele and seroma formation, the absence of recurrence may imply initial treatment efficacy or a naturally reduced propensity for recurrence of these conditions. Nonetheless, it is crucial to maintain vigilant surveillance despite the lack of recurrence; scholarly works do document occurrences in which these complications resurface, especially in situations where initial management was inadequate 40,41 …”

Comparison of the effect of ultrasounic-harmonic scalpel and electrocautery in the treatment of axillary lymph nodes during radical surgery for breast cancer

“…In addition, there was no significant difference in postoperative retention time of axillary drainage tube, postoperative incision pain perception, and the probability of near-term postoperative complications were roughly the same between the two groups. Studies have shown that axillary drainage flow and axillary drainage tube indwelling time are closely related to postoperative lymphedema occurrence, postoperative recovery time, and tumor prognosis of patient s[ 32 – 34 ].…”

Frequency of seroma formation after modified radical mastectomy. A comparison between electrocautery and scalpel dissection techniques.

“…Patient have to visit outpatient department frequently and leads to delay in start of adjuvant chemotherapy and radiotherapy. 10 Dissection during surgery leads to formation of acute inflammatory exudates and damage of lymphatics resulting in lymph leakage are leading causes of seroma formation. 11 Several dissection techniques are applied to reduce seroma formation but there is no consensus on a single method.…”