Should a Drain Be Placed in Early Breast Cancer Surgery?

Ebner, Florian; deGregorio, N; Vorwerk, Elena; Janni, Wolfgang; Wöckel, Achim; Varga, Dominic

doi:10.1159/000360928

Cited by 10 publications

(8 citation statements)

References 56 publications

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“…Previous research into the effectiveness of prophylactic drainage in reducing the incidence of complications following gastrointestinal, 25 vascular, 26 thyroid, 27 and breast cancer surgery 28,29 have not universally substantiated a benefit to drainage. Additionally, the presence of a prophylactic drain remaining in a postoperative wound may increase the risk of infection of the surgical site and be a cause of postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Wound Drainage in Renal Transplantation: A Systematic Review

D’Souza

Crowley

Hameed

et al. 2019

Transplantation Direct

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Background. Adult kidney transplantation is most commonly into an extraperitoneal potential space, and surgically placed drains are used routinely in many centers. There is limited evidence of clinical benefit for prophylactic drainage in other major abdominal and vascular surgery. Transplantation is, however, a unique setting combining organ dysfunction and immunosuppression, and the risks and benefits of prophylactic drain placement are not known. This study attempts to examine existing literature to determine whether prophylactic intraoperative drains have an impact on the likelihood of perigraft fluid collections and other wound-related complications following kidney transplantation. Methods. A literature search of MEDLINE and EMBASE was conducted to identify published comparative studies, including recipients receiving prophylactic drains to recipients in whom drains were omitted. The main outcomes were the incidence of peritransplant fluid collections and wound-related complications. Meta-analysis was performed on these data. Results. Four retrospective cohort studies were deemed eligible for quantitative analysis and 1 additional conference abstract was included in qualitative discussion. A total of 1640 patients, 1023 with drains and 617 without, were included in the meta-analysis. There was a lower rate of peritransplant collections associated with the drain group (RR 0.62; 95% confidence interval, 0.42-0.90). There was no significant difference in the incidence of wound-related complications between the groups (RR 0.85; 95% confidence interval, 0.34-2.11). Conclusions. These data associate a higher rate of peritransplant fluid collections with omission of prophylactic drainage, without a difference in the incidence of wound-related complications. Further research is required to definitively determine the impact of drains in this patient group.

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Section: Introductionmentioning

confidence: 99%

Prophylactic Wound Drainage in Renal Transplantation: A Systematic Review

D’Souza

Crowley

Hameed

et al. 2019

Transplantation Direct

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“…Among breast cancer patients undergoing surgery, this rate can be as high as 90% 16 , 17 . However, over recent years, the possibility of not draining the axilla has been studied 11 , 12 since seroma formation rates tend to remain very high even with the use of drains 18 . This complication occurs secondary to the disruption of lymph channels, an inevitable consequence of extensive surgical dissection and disruption of tissue planes, creating a dead space 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Axillary drainage has become a subject of debate in recent years since it tends to prolong hospitalization times 11 and creates discomfort, exerting a negative psychological impact on patients who have undergone this treatment 5 , 12 , 13 . Drainage is also associated with limitations to activities of daily living that may include difficulty in dressing and problems with sleeping 13 .…”

Section: Introductionmentioning

confidence: 99%

“…Drainage is also associated with limitations to activities of daily living that may include difficulty in dressing and problems with sleeping 13 . Consequently, some studies have been conducted to evaluate the possibility of not draining the surgical site following axillary dissection 9 , 11 , 12 . However, controversy persists regarding the need to use continuous drainage 9 , with the debate being mainly motivated by doubts that not performing drainage could increase the rate of complications, particularly in patients undergoing complete axillary dissection (levels I, II and III).…”

Section: Introductionmentioning

confidence: 99%

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Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

Freitas‐Junior¹,

Ribeiro²,

Moreira³

et al. 2017

Clinics

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OBJECTIVE:This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection.METHODS:The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552.RESULTS:The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 – 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups.CONCLUSION:Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

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“…Data showed that the use of drains was associated with a prolonged hospitalization in 50% of BC. This finding is consistent with an analysis of five systematic reviews which concluded that the insertion of a drain is associated with a longer hospital stay and reduced seroma formation …”

mentioning

confidence: 99%