Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons

Spiekerman van Weezelenburg, Merel A.; Bakens, Maikel J. A. M.; Daemen, Jean H. T.; Aldenhoven, Loeki; van Haaren, Elisabeth R. M.; Janssen, Alfred; Vissers, Yvonne L. J.; Beets, Geerard L.; van Bastelaar, James

doi:10.1245/s10434-023-14631-9

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…16 The incidence of seroma formation in our study was lesser than what has been reported, which may be due to our cutoff for drain removal (<20 mL on two consecutive days) being lower than other researchers who have utilized various cutoffs ranging from 20 to 50 mL. 17 TA has been shown to decrease the volume and duration of axillary drainage in previous nonrandomized and randomized studies. Besides, the rate of seroma formation and wound infection may also be lower with the use of systemic TA.…”

Section: Discussioncontrasting

confidence: 63%

Efficacy of perioperative systemic tranexamic acid along with topical hemocoagulase in decreasing axillary drain output in breast cancer patients undergoing axillary lymph node dissection: A randomized, double‐blind, placebo‐controlled, superiority trial

Verma,

Jha,

Singh

et al. 2024

World j. surg.

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BackgroundExcess and prolonged axillary drainage is a frequent nuisance following axillary lymph node dissection (ALND) in breast cancer patients. No consensus exists about the best method to prevent this consistently and reliably. Tranexamic acid (TA) has been found to reduce the amount and duration of drainage, but the reduction is not optimal. We hypothesized that systemic administration of TA along with the topical application of hemocoagulase (H) to the axillary dissection bed may decrease the cumulative axillary drain output and shorten the requirement of drainage after ALND as compared to placebo.Patient and MethodsSeventy women undergoing ALND for breast carcinoma were randomized into two groups, the intervention (TA + H) group and the control (C) group. The cumulative drain output (primary objective), duration of drainage, incidence of seroma formation after drain removal, number of seroma aspirations required, volume of seroma aspirated, and incidence of surgical site infection (SSI) were compared.ResultsThe mean cumulative output in the TA + H group was significantly lower than the C group (290 ± 200 mL vs. 552 ± 369 mL, p < 0.001). Axillary drains were removed significantly earlier in the TA + H group (6.6 ± 2.2 vs. 11.7 ± 6.0 days, p < 0.001), but the incidence of seroma formation (p = 0.34), number of aspirations required (p = 0.33), volume of seroma aspirated (p = 0.47), and the incidence of SSI (p = 0.07) were similar.ConclusionsPerioperative systemic administration of tranexamic acid along with topical application of H to the axillary dissection bed is effective in reducing cumulative axillary drain output after ALND. This strategy may also facilitate earlier removal of suction drains.

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Section: Discussioncontrasting

confidence: 63%

Efficacy of perioperative systemic tranexamic acid along with topical hemocoagulase in decreasing axillary drain output in breast cancer patients undergoing axillary lymph node dissection: A randomized, double‐blind, placebo‐controlled, superiority trial

Verma,

Jha,

Singh

et al. 2024

World j. surg.

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“…Axillary lymph node dissection (ALND) provides accurate axillary staging and maintains region control, however, it has many postoperative complications, including lymphedema, nerve injury, impaired mobility, etc., which significantly reduces the quality of life of patients [4,5]. Since the 1990s, sentinel lymph node biopsy (SLNB) has gradually replaced ALND as a standard axillary staging operation for patients with clinically node negative early-stage breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting axillary lymph node burden of early-stage breast cancer

Cai,

Ju,

Dang

et al. 2024

Preprint

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Purpose To identify ultrasonic and clinicopathological features associated with high axillary lymph node (ALN) burden ( > 2 metastatic ALNs) and develop a nomogram for preoperatively predicting ALN burden in patients with early-stage breast cancer. Methods In this retrospectively study, a total of 575 women with clinical T1-2N0 breast cancer confirmed by histopathology were included from January 2021 to June 2023. Patients were randomly divided into a training set (n = 403) and a validation set (n = 172). According to the pathological results of the axilla, patients were divided into low burden group and high burden group. Univariate and multivariate logistic regression analysis were performed to determine the risk factors and develop the nomogram. The performance of the nomogram was assessed by receiver operating characteristic (ROC) curves, the calibration curves and decision curve analysis in the training and validation sets. Results In the training and validation sets, 10.4% (42/403) and 10.5% (18/172) of patients showed high burden, respectively. Univariate and multivariate analysis indicated that the distance from the nipple (P = 0.007), cortical thickness (P < 0.001), number of abnormal LNs on ultrasound (P = 0.001) were independent predictors of ALN burden. The nomogram showed good discrimination with AUC values of 0.878 and 0.837 in the training and validation sets, respectively. The calibration curves demonstrated good agreement between predictions of nomogram and pathologic results. And the clinical net benefit was ideal based on decision curves analysis. Conclusion The nomogram developed in this study has good performance for non-invasively predicting ALN burden in early-stage breast cancer and might provide reference for clinical treatment decision-making.

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Methods of Controlling Postoperative Complications after Lymphadenectomy in Patients with Breast Cancer

Bukin,

Vasin,

Goloshchapova

et al. 2024

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. Reducing the aggressiveness of surgical tactics is currently considered a promising trend in medicine that is widely supported due to its better safety profile. However, a large percentage of patients need more intervention. In the treatment of breast cancer, the main difficulties in postoperative management are associated with lymphatic surgery. Aim. To perform a comparative analysis of techniques for intraoperative control of lymphorrhea in patients during lymph node dissection for breast cancer in Yaroslavl Regional Oncologic Hospital. Materials and methods. Case histories of 660 patients after axillary subclavian subscapular lymphadenectomy were analyzed. In the postoperative period, patients revealed prolonged lymphorrhea. Magnifying techniques (binocular lenses, microscope) were used during the interventions to detect and isolate lymphatic vessels in 108 patients. A double coagulation technique was used to ligate the lymphatic vessels. Sufficient coagulation surface was achieved by forming suture lines of an angle greater than 90°. When performing a mastectomy, the technique was supplemented by circular bandaging of the chest. Results and discussion. Analysis of case histories showed that lymphadenectomy proved to be the main significant factor influencing lymphorrhea. Sparing techniques reduced the risk of postmastectomy syndrome. Comparing the study group with the control group revealed a statistically significant reduction in the severity of lymphorrhea without an increase in the risk of other complications. Conclusion. The combination of these techniques demonstrated statistically significant advantages in controlling postoperative complications. The techniques are easy to perform, therefore, they can be introduced into practice with minimal costs. The economic benefits are associated with the absence of additional costs for surgery, as well as with a reduction in the duration of hospital stay for patients. All this significantly increases patient satisfaction with the treatment performed.

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Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons

Cited by 3 publications

References 37 publications

Efficacy of perioperative systemic tranexamic acid along with topical hemocoagulase in decreasing axillary drain output in breast cancer patients undergoing axillary lymph node dissection: A randomized, double‐blind, placebo‐controlled, superiority trial

Efficacy of perioperative systemic tranexamic acid along with topical hemocoagulase in decreasing axillary drain output in breast cancer patients undergoing axillary lymph node dissection: A randomized, double‐blind, placebo‐controlled, superiority trial

Development and validation of a nomogram for predicting axillary lymph node burden of early-stage breast cancer

Methods of Controlling Postoperative Complications after Lymphadenectomy in Patients with Breast Cancer

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