Retrospective Evaluation of the Effectiveness of a Synthetic Glue and a Fibrin-Based Sealant for the Prevention of Seroma Following Axillary Dissection in Breast Cancer Patients

Abstract

Introduction: Seroma formation represents one of the most frequent postoperative complications of axillary dissection in breast cancer (BC) patients. We aimed to retrospectively explore the effectiveness of the intraoperative use of a synthetic cyanoacrylate glue (specifically Glubran®2) vs. the intraoperative use of a fibrin sealant (specifically Tisseel) in reducing seroma formation compared to the use of nonsealant in BC patients who underwent breast surgery and axillary dissection. Materials and Methods: We conducted a retrospective, monocentric observational study on BC patients who underwent axillary dissection associated with breast surgery. The axillary dissection was completed with the application of a closed suction drain and was preceded by the application of either Glubran®2 glue or Tisseel sealant or nonsealant. We analyzed the quantity of serum drained in the first 3 postoperative days, length of hospitalization, days of permanence of axillary drain, seroma development, and presence of postoperative infection signs. Results: Forty-one BC patients were considered. Based on the device used during the surgical treatment, the patients were divided into three groups: group A (17 patients), to whom suction axillary drain was applied; group B (7 patients), to whom Tisseel and axillary suction drain were applied; and group C (17 patients), to whom Glubran®2 and axillary suction drain were applied. Among the three groups, we did not find significant differences in terms of amount of serum drained in the first 3 postoperative days, length of hospitalization, and incidence of seroma. Group C maintained the axillary drain in a significantly lower number of days compared to the other two groups (p = 0.02); it also had a lower incidence of postoperative infections (6%) compared to group A (23%) and group B (57%) (p = 0.02). Conclusions: We did not find any evidence that the use of surgical glues may reduce the formation of seroma following axillary dissection in BC patients. Nevertheless, the use of cyanoacrylate glue in association with closed suction axillary drain seems to contribute to the reduction in days of axillary drain permanence and of postoperative infections, which are known factors delaying the schedule of any adjuvant oncological therapies.

A six-gene signature related with tumor mutation burden for predicting lymph node metastasis in breast cancer

“…Lymph node status was identified as an important prognostic factor in BC and patients with lymph node metastasis had a worse survival outcome than those without metastatic status (3,4). Moreover, BC patients with lymph node metastasis often suffer from sentinel lymph node biopsy or axillary dissection, taking a risk of many serious complications, such as lymphedema, chyle leak, seroma formation and so on (5)(6)(7). Therefore, it is urgent for clinicians to search for potential biomarkers to predict the lymph node metastasis in BC.…”

Early Disturbance of Lymphatic Transport as a Risk Factor for the Development of Breast-Cancer-Related Lymphedema

“…However, postsurgical infection is most often reported as a risk factor for the development of BCRL [ 15 , 45 , 46 ]. Prevention of postoperative seromas and infections remains an important issue, and further research is needed [ 47 ].…”

New classifications of axillary lymph nodes and their anatomical-clinical correlations in breast surgery

“…The advent of SLN biopsy procedure has changed the axilla's surgical management in breast cancer patients, avoiding ALND in selected patients [25]. However, for those patients with clinically positive axillary lymph node, ALND still represents the standard of care, although associated with substantial morbidity, including upper limb lymphedema, potential shoulder dysfunction and discomfort, and numbness [26][27][28].…”