The Use of Hemostatic Agents to Decrease Bleeding Complications in Breast Cancer Surgery

Abstract

Introduction Following breast cancer surgery, patients often require adjuvant radiation and chemotherapy for locoregional and systemic disease control. These procedures may result in postoperative complications, which may delay adjuvant therapy. To potentially decrease these complications, hemostatic agents may be used. This study evaluated the rate of postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in oncologic breast surgery with and without hemostatic agents. Methods After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent oncoplastic breast surgery, mastectomy with or without expander/implant-based reconstruction, and subsequent reconstruction with expander to implant exchange were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL®, Ethicon, USA) or combination powder (CP, HEMOBLAST™ Bellows, biom’up, France), length of follow-up, time to JP drain removal, and post-operative complications (seroma, hematoma, or operating room (OR) takeback). This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP. Results The use of a hemostatic agent resulted in fewer bleeding complications and significantly decreased time until JP drain removal. Although not significant, subgroup analysis demonstrated that this was more pronounced in the CP group. JP drain duration was decreased among all procedures for CP compared to FS. Conclusions The use of hemostatic agents in oncologic breast surgery may result in decreased postoperative complications and significantly reduce time to JP drain removal.

Use of polysaccharide hemostatic agent (HaemoCer™) in breast cancer surgery to reduce postoperative complications: A randomised controlled trial

“… 6 Specifically the effect of fibrin sealant containing human thrombin or combined hemostatic powder containing collagen, thrombin and chondroitin sulfate has been evaluated in the past, resulting in early drainage removal and increased day‐case surgery. 15 , 17 , 18 Furthermore, natural polysaccharide hemostatic agents have as well shown high biocompatibility and good hemostatic characteristics, 19 but there is a paucity of data regarding the application during breast‐conserving surgery and its effect. Hence, we aimed to evaluate the hemostatic performance of polysaccharide agents in breast‐conserving surgery with a prospective randomised‐controlled study.…”

“…Available data from a study based on retrospective chart reviews however also suggests a benefit regarding reduction of postoperative bleeding complications and time until drain removal. 15 …”

“…Fewer data exist on the effect of hemostatic agent application into the wound site during breast‐conserving surgery. Available data from a study based on retrospective chart reviews however also suggests a benefit regarding reduction of postoperative bleeding complications and time until drain removal 15 …”

Use of polysaccharide hemostatic agent (HaemoCerTM) in breast cancer surgery to reduce postoperative complications: a randomized controlled trial

“…While intraoperative control of bleeding remains pivotal for the reduction of postoperative complications, the application of topical hemostatic agents has become very common in the last two decades 18 . Specifically the effect of fibrin sealant containing human thrombin or combined hemostatic powder containing collagen, thrombin and chondroitin sulfate has been evaluated in the past, resulting in early drainage removal and increased day-case surgery 15,17,19 . Furthermore, natural polysaccharide hemostatic agents have as well shown high biocompatibility and good hemostatic characteristics 20 , but there is a paucity of data regarding the application during breast-conserving surgery and its effect.…”

“…Fewer data exists on the effect of hemostatic agent application into the wound site during breast-conserving surgery. Available data from a study based on retrospective chart reviews however also suggests a benefit regarding reduction of postoperative bleeding complications and time until drain removal 15 .…”