Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer

Purushotham, Arnie; McLatchie, Elsbeth; Young, David; George, W D; Stallard, Sheila; Doughty, Julie; Brown, Denise; Farish, C; Walker, Anna; Millar, Keith; Murray, Gordon D.

doi:10.1046/j.0007-1323.2001.02031.x

Cited by 114 publications

(91 citation statements)

References 20 publications

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“…6 Avoidance of drainage in patients undergoing breast conserving surgery with axillary lymphadenectomy resulted in 92% of patients developing ultrasound detected seroma in one study, but only half of these required aspiration. 8 Previous studies have attempted to reduce seroma formation by early patient discharge with drains in situ, 9,10 external compression dressings 11 or by reduction of axillary 'dead-space' by introducing rows of sutures 6,12,13 or bovine thrombin spray.…”

Section: Resultsmentioning

confidence: 97%

Day-case breast cancer axillary surgery

Athey

Gilliam²,

Sinha³

et al. 2005

Ann R Coll Surg Engl

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96Ann R Coll Surg Engl 2005; 87 B reast cancer is the commonest malignancy in women 1 with 29,000 new cases per year being diagnosed in England and Wales. The aggressive approach with radical surgery has changed over the years to being more conservative.2 Standard treatment for most women, now, is excision of the primary tumour (by wide local excision or mastectomy) with axillary lymphadenectomy. This permits locoregional control, staging and accurate prognostication. Suction drainage of the axilla is standard practice to prevent seroma formation 4 but practice varies about the length of time required for axillary drainage with patients frequently having a hospital stay of 5-8 days. 5A recent randomised trial 6 advocated the suturing of flaps, avoidance of drainage and early discharge with patients having a 3.31 day-stay after undergoing wide local excision and level 2 axillary clearance for breast cancer. This compared to a 4.86 day-stay for patients in the control group who had axillary suction drainage until drain output was less than 50 ml over 24 h (P < 0.05).Day-case axillary lymph node surgery (ALNS) for breast carcinoma has been performed at the University Hospital of North Tees for over 6 years. When patients are seen in the breast clinic, their ability to undergo day-case surgery is assessed by ensuring that there is no significant Results: 165 patients underwent intended day-case axillary surgery (axillary dissection level 1/2; median age, 55 years; range, 39-76 years). Of these, 16 (9.7%) were admitted overnight usually due to over-running of theatre lists (n = 13; 81%). 29 patients (17.6%) underwent axillary dissection alone, the remainder had axillary surgery combined with wide local excision (median number of lymph nodes excised 11; range, 2-18). Complications included symptomatic seroma formation in 37 patients (22%) and wound infection in 16 patients (10%). Conclusions: Day-case axillary surgery can be performed safely with surgical morbidity comparing favourably to published work of 'traditional' axillary drainage following lymphadenectomy.

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Section: Resultsmentioning

confidence: 97%

Day-case breast cancer axillary surgery

Athey

Gilliam²,

Sinha³

et al. 2005

Ann R Coll Surg Engl

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“…Although it is possible to discharge patients early without a wound drain in situ (Purushotham et al, 2002), this has not become standard practice. This trial provides further evidence that early discharge for patients recovering from axillary clearance for breast cancer is safe (Bonnema et al, 1998a;Bundred et al, 1998;Horgan et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

et al. 2004

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Patients with breast cancer who require axillary clearance traditionally remain in hospital until their wound drains are removed. Early discharge has been shown to improve clinical outcomes, but there has been little assessment of the psychosocial and financial impact of early discharge on patients, carers and the health service. This study aimed to evaluate the effectiveness of a nurse-led model of early discharge from hospital. Main outcome measures were quality of life and carer burden. Secondary outcomes included patient satisfaction, arm morbidity, impact on community nurses, health service costs, surgical cancellations and in-patient nursing dependency. A total of 108 patients undergoing axillary clearance with mastectomy or wide local excision for breast cancer were randomised to nurse-led early discharge or conventional stay. Nurse-led early discharge had no adverse effects on quality of life or patient satisfaction, had little effect on carer burden, improved communication between primary and secondary care, reduced cancellations and was safely implemented in a mixed rural/urban setting. In total, 40% of eligible patients agreed to take part. Nonparticipants were significantly older, more likely to live alone and had lower emotional well being before surgery. This study provides further evidence of the benefits of early discharge from hospital following axillary clearance for breast cancer. However, if given the choice, most patients prefer to stay in hospital until their wound drains are removed.

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“…There are authors who do not insert drain after breast cancer surgery because of the belief that it does not prevent seroma formation and is associated with increased wound complications, patient's discomfort and prolongs hospital care [35,36]. Talbot and Magarey [37] grouped 90 consecutive patients who had axillary dissection for breast cancer into those with prolonged drainage, short drainage and no drain and reported the difference in the complication rates or the duration of fluid accumulation in these three groups.…”

Section: Drain Versus No Drainmentioning

confidence: 99%

Seroma Formation after Mastectomy: Pathogenesis and Prevention

Sampathraju

Rodrigues

2010

Indian J Surg Oncol

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Post mastectomy seroma remains an unresolved quandary as the risk factors for its formation have still not been identified. Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. Various techniques and their modifications have been practiced and published in English literature, but there seems to be no consensus. In this article, all aspects of seroma formation from pathogenesis to prevention including drug therapies have been discussed.

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Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer

Abstract: Wound drainage following surgery for breast cancer can be avoided, thereby facilitating early discharge with no associated increase in surgical or psychological morbidity.

Cited by 114 publications

References 20 publications

Day-case breast cancer axillary surgery

Day-case breast cancer axillary surgery

Patient, carer and health service outcomes of nurse-led early discharge after breast cancer surgery: a randomised controlled trial

Seroma Formation after Mastectomy: Pathogenesis and Prevention

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