1
|
Sanjeeviah RC, Bandimegal M, Patil V, Telkar KG, Gowda NS. Povidone Iodine Sclerotherapy for the Treatment of Persistent Seromas after Breast Cancer Surgery. Indian J Surg Oncol 2023; 14:81-87. [PMID: 36891446 PMCID: PMC9986158 DOI: 10.1007/s13193-022-01629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/18/2022] [Indexed: 10/15/2022] Open
Abstract
Persistent seroma following breast cancer surgery causes morbidity and delays adjuvant treatment. Sclerotherapy helps in managing recalcitrant seromas. We evaluated efficacy of 10% povidone iodine sclerotherapy treatment for persistent seromas after breast cancer surgery. Persistent drainage of > 100 mL/day 15 days following surgery, and seromas that required aspiration > 100 mL/week 2 weeks after drain removal, was considered for 10% povidone sclerotherapy in a non-randomized observational study. Resolution (drain output < 20 mL/day), treatment days, recurrence, and complications were assessed as measures of efficacy. Descriptive measures of central tendency and dispersion were reported. The relationship of the seroma quantity with risk factors (age, body mass index, levels and number of axillary lymph nodes dissected, neoadjuvant chemotherapy) and efficacy was analysed. We examined the correlation using Pearson and Spearman' signed rank, Student's t, and Mann-Whitney U-tests, to compare the means. Of 14/312 (4.5%) patients with persistent seroma, 13 (92.8%) had complete resolution after sclerotherapy within 6.71 days (range: 6-8). AC (p = 0.04), neoadjuvant chemotherapy (NACT) (p = 0.005), and number of nodes harvested without NACT (p = 0.025) were significantly associated with the quantity of discharge, while age (p = 0.072), body mass index (p = 0.432), type of surgery (breast conservation surgery vs. modified radical mastectomy) (p = 0.28), and total number of axillary lymph nodes (p = 0.679) were not. When used in this unique innovative manner, 10% povidone iodine sclerotherapy was found to be very effective (93%), minimally invasive, and safe in our study, and therefore appears to be an ideal sclerosing agent. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01629-0.
Collapse
Affiliation(s)
- Ravinder Chowrappa Sanjeeviah
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Mahesh Bandimegal
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Vijayraj Patil
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Kanmani Govindrao Telkar
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Naveen Shivanna Gowda
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| |
Collapse
|
2
|
Wienerroither V, Hammer R, Kornprat P, Schrem H, Wagner D, Mischinger HJ, El-Shabrawi A. Use of LigaSure vessel sealing system versus conventional axillary dissection in breast cancer patients: a retrospective comparative study. BMC Surg 2022; 22:436. [PMID: 36544128 PMCID: PMC9773442 DOI: 10.1186/s12893-022-01888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and-most frequently-seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome. METHODS A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid. RESULTS Seventy one female patients with a median age of 63 (30-83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005). CONCLUSION LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.
Collapse
Affiliation(s)
- V. Wienerroither
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - R. Hammer
- Department of Surgery, LKH Graz II, Graz, Austria
| | - P. Kornprat
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. Schrem
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - D. Wagner
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - H. J. Mischinger
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - A. El-Shabrawi
- grid.11598.340000 0000 8988 2476Department of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| |
Collapse
|
3
|
Rehabilitation for women undergoing breast cancer surgery: a systematic review and meta-analysis of the effectiveness of early, unrestricted exercise programs on upper limb function. Clin Breast Cancer 2022; 22:650-665. [DOI: 10.1016/j.clbc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
|
4
|
Klein I, Kalichman L, Chen N, Susmallian S. A pilot study evaluating the effect of early physical therapy on pain and disabilities after breast cancer surgery: Prospective randomized control trail. Breast 2021; 59:286-293. [PMID: 34340163 PMCID: PMC8342784 DOI: 10.1016/j.breast.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Morbidity of the shoulders after breast cancer (BC) surgery is a common side effect that includes; persistent pain, function limitation, and decreased range of motion (ROM). This study examines the effect of early physical therapy (PT) and patient's education on these morbidities. Methods A prospective, randomized clinical trial was conducted at a single medical center from October 2018 until April 2019. Women scheduled for breast cancer surgery were divided into intervention or control as standard care. The intervention included a PT treatment that included exercise instructions from the first postoperative day. Pain levels, upper limb function, ROM, and complications were measured. Results The study includes 157 women (mean age, 52.2 ± 12.9). Early PT reduced pain levels at the first month (NPRS 1.5 ± 1.2) and six months (NPRS 0.5 ± 0.8), compared with control (NPRS 2.1 ± 1.4, 1.0 ± 1.2), p = 0.019 and p = 0.011, respectively. Subdivision of the sample into small and extensive surgeries revealed additional positive effect for the intervention six months postoperatively on functional disabilities, p = 0.004 and p = 0.032 respectively. No complications attributable to the intervention were recorded. Conclusions Early PT and patient education reduces pain levels, and may improve function disabilities, without causing postoperative complications, although a larger study is needed to achieve unequivocal results. In breast cancer surgeries frequently delay the start of physical activities, arguing that it involves complications. The shoulder after breast surgery may provoke prolonged pain, disabilities, and prolongs recovery time. Physical therapy given the day after surgery, does not cause postoperative complications. Early onset of exercise regarding function and pain during recovery, may help reduce pain levels.
Collapse
Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel; Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
5
|
|
6
|
Piñero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrión J, Canteras-Jordana M. Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol 2016; 114:423-7. [PMID: 27338717 DOI: 10.1002/jso.24344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy. METHODS A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed. RESULTS Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060]). CONCLUSIONS Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Antonio Piñero-Madrona
- Department of General Surgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | | | | | | |
Collapse
|
7
|
Turner EJH, Benson JR, Winters ZE. Techniques in the prevention and management of seromas after breast surgery. Future Oncol 2015; 10:1049-63. [PMID: 24941989 DOI: 10.2217/fon.13.257] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Seromas are the most frequent complications following breast surgery, resulting in significant discomfort and morbidity with possible delays in commencing adjuvant therapies. Varied clinical practices exist in the techniques employed to prevent and manage seromata. This article assesses published literature on the techniques employed in prevention of seroma formation following breast surgery, evaluating the different methodologies used. Although prevention is the best strategy, seromata remain problematic and we consider their management. The principle findings were that prevention is key to the management of seromata. Methods employed to prevent seromata include suction drainage, shoulder immobilization, quilting sutures, fibrin sealants and innovative measures of managing the axilla, among others. The evidence demonstrated that a combination of quilting and drains significantly reduces the incidence and volumes of seromata. These effects are sustained by minimizing use of electrocautery, alongside increasing frequencies of axillary sentinel lymph node biopsies and node sampling. The efficacy data on fibrin sealants is inconclusive and consequently should not be routinely used alone or accompanied by quilting sutures. Clinically significant seromas deemed 'symptomatic' by patients and complicating infected seromas should be aspirated. There are limited data on the recommended treatment of established seromas with a paucity of high-quality studies and further research involving randomized trials are indicated.
Collapse
Affiliation(s)
- E Jane H Turner
- Department of Surgery, Croydon University Hospital, 530 London Road, Thornton Heath, Surrey, CR7 7YE, UK
| | | | | |
Collapse
|
8
|
Eser M, Gökçeimam M, Eyvaz K, Tutal F, Geçer MÖ, Göktaş S, Uzun H, Kaptanoglu L, Kurt N. Effect of local bleomycin sulfate application on seroma formation in a rat mastectomy and axillary lymph node dissection model. Eur J Pharmacol 2014; 723:375-80. [DOI: 10.1016/j.ejphar.2013.10.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 10/22/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
|
9
|
Taylor JC, Rai S, Hoar F, Brown H, Vishwanath L. Breast cancer surgery without suction drainage: the impact of adopting a 'no drains' policy on symptomatic seroma formation rates. Eur J Surg Oncol 2013; 39:334-8. [PMID: 23380200 DOI: 10.1016/j.ejso.2012.12.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/10/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022] Open
Abstract
AIM To determine the effect of a 'no drains' policy on seroma formation and other complications in women undergoing breast cancer surgery. MATERIALS AND METHODS Before May 2010 drains were routinely used in our unit following mastectomy ± axillary surgery and axillary lymph node dissection (ALND) ± wide local excision (WLE). Since then, a 'no drains' policy has been adopted. Data was collected prospectively between 01/12/06 and 30/11/11 to compare symptomatic seroma, wound infection, re-admission and re-operation rates in women treated with a drain and those without. RESULTS 596 women were included in the study. 247 women underwent modified radical mastectomy (MRM) and ALND (Group 1), 184 MRM ± sentinel lymph node biopsy (SLNB)/axillary node sampling (ANS) (Group 2) and 165 ALND ± WLE (Group 3). In group 1, 149 had a drain, in group 2, 62, and in group 3, 50. Within each group, the presence or absence of a drain did not significantly affect the rate of symptomatic seroma, number of aspirations performed, wound infection rates or the incidence of complications requiring re-admission. Having a drain was associated with lower volumes of seroma aspirated. In all three groups, the presence of a drain was associated with a longer hospital stay (p < 0.001). CONCLUSION This study suggests that MRM ± ALND/SLNB/ANS and ALND ± WLE can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a 'no-drains' policy may also contribute to earlier hospital discharge.
Collapse
Affiliation(s)
- J C Taylor
- Department of Breast Surgery, City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham B18 7QH, UK.
| | | | | | | | | |
Collapse
|
10
|
Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 2012; 15:373-80. [PMID: 23346164 PMCID: PMC3542843 DOI: 10.4048/jbc.2012.15.4.373] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022] Open
Abstract
Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Seroma has been defined as serous fluid collection under the skin flaps or in the axillary dead space following mastectomy and/or axillary dissection. Because the true etiology of a seroma is unknown, a multifactorial-causation hypothesis has been accepted. Surgical factors include technique, extent of dissection and the surgical devices used for dissection. Obliteration of dead space with various flap fixation techniques, use of sclerosants, fibrin glue and sealants, octreotide, and pressure garments have been attempted with conflicting results and none have been consistent. Early movement of the shoulder during the postoperative period may increase the formation of seroma, although delayed physiotherapy decreases the formation of seroma. A detailed analysis of the use of drains showed that use of single or multiple drains, early or late removal, and drains with or without suction are not significantly different for the incidence of seroma. Although there is evidence for reduced seroma formation after early drain removal, very early removal within 24 hours seems to increase formation of seroma. No patient or tumor factors seem to affect seroma formation except body mass index and body weight. Consensus is lacking among studies/trials with different groups producing conflicting evidence. Besides a few established factors such as body mass index, the use of electrocautery for dissection, early drain removal, low vacuum drains, obliteration of dead space, and delayed shoulder physiotherapy, most of the hypothesized causes have not been demonstrated consistently. Thus, seroma remains a threat to both the patient and surgeon. Recurrent transcutaneous aspiration remains the only successful management.
Collapse
Affiliation(s)
- Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | | |
Collapse
|
11
|
Eser M, Tutal F, Kement M, Goktas S, Kaptanoglu L, Gökceimam M, Gecer MO, Uzun H. Effects of local phenytoin on seroma formation after mastectomy and axillary lymph node dissection: an experimental study on mice. BMC Surg 2012; 12:25. [PMID: 23253781 PMCID: PMC3563462 DOI: 10.1186/1471-2482-12-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/04/2012] [Indexed: 12/03/2022] Open
Abstract
Background Seroma formation is the most common complication after breast cancer surgery. It is an important complication since it prolongs therapy duration, increases cost, and negatively affects patient psychology. Currently, there is no widely accepted method that prevents seroma formation. We tried to investigate impact of local phenytoin application on seroma formation following an experimental mastectomy model created in rats. Methods Two groups including eight rats in each were randomized. Saline injection was applied in the first group, whereas 1% phenytoin was locally used in the second group. Ten days after the surgery, seroma formation and wound-healing processes were evaluated using histopathological and biochemical examinations. Results Phenytoin significantly decreased seroma formation. Fibrosis was significantly increased and angiogenesis was significantly reduced in the phenytoin group (P < 0.05). Increased levels of macrophage and lymphocyte infiltration was detected in the control group (P < 0.05). No difference was detected between the groups in terms of necrosis, edema, congestion, and PNL (Polymorphonuclear leucocyte) and fibroblast infiltration. Conclusions Seroma formation-reducing effect of phenytoin might have occurred over its anti-inflammatory, anti-angiogenetic, and fibrosis augmenting effects.
Collapse
Affiliation(s)
- Mehmet Eser
- Department of General Surgery, Kartal Training and Research Hospital, Kartal, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Luo C, Guo W, Yang J, Sun Q, Wei W, Wu S, Fang S, Zeng Q, Zhao Z, Meng F, Huang X, Zhang X, Li R, Ma X, Luo C, Yang Y. Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer: long-term results from a randomized, multicenter trial. Mayo Clin Proc 2012; 87:1153-61. [PMID: 23146657 PMCID: PMC3541933 DOI: 10.1016/j.mayocp.2012.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 07/02/2012] [Accepted: 07/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the long-term results of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND). PATIENTS AND METHODS From January 1, 2003, through December 31, 2005, a group of 1027 consecutive patients with operable breast cancer were randomly assigned to 1 of 2 study groups: MALND and CALND. The median follow-up was 63 months. The primary end points of the study were operative outcomes, complication reduction, function conservation, and cosmetics. The secondary end points were disease-free and overall survival. RESULTS The mean operative blood loss in the MALND group was less than in the CALND group (P<.001). The patients who underwent MALND had less axillary pain, numbness or paresthesias, and arm swelling (P<.001). The aesthetic appearance of the axilla in the MALND group was much better than that in the CALND group (P=.001 at 6 months and P=.002 at 24 months). A significant difference was found between the 2 groups in distant metastasis (P=.04). The disease-free survival rate was 64.5% in the MALND group and 60.8% in the CALND group (P=.88). The overall survival rate was 81.7% in the MALND group and 78.6% in the CALND group (P=.95). CONCLUSION Compared with CALND, MALND has advantages in operative outcomes, complication reduction, function conservation, and cosmetics.
Collapse
Affiliation(s)
- Chengyu Luo
- Fuxing Hospital, Capital Medical University, Beijing, China.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Efficacy of fibrin glue on seroma formation after breast surgery. Int J Breast Cancer 2012; 2012:643132. [PMID: 23008776 PMCID: PMC3447350 DOI: 10.1155/2012/643132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/16/2012] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives. This study was designed to determine the effectiveness of fibrin glue plus conventional drain placement versus conventional drain placement in the prevention of seromas after breast procedures. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results. Design and Setting. A prospective, randomized, controlled study of subjects who were randomized into control and experimental groups was conducted. Methods. Collected data included age, surgeon, medical and surgical history, comorbidities, procedure performed, number of axillary nodes, number of positive axillary nodes collected, final pathologic diagnosis, cancer stage, hospital stay, postoperative day of drain removal, complications, incidence of seroma formation, interval to seroma resolution, and number of postoperative visits. Results. Analysis of 60 patients showed similarly matched groups. Seroma formation rate was 24.1% in the control group and 16.1% in the fibrin glue group. The rate of wound complications was similar. Conclusions. Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost and cumbersome technique tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.
Collapse
|
14
|
Sakkary MA. The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surg Oncol 2012; 10:8. [PMID: 22236813 PMCID: PMC3279306 DOI: 10.1186/1477-7819-10-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/11/2012] [Indexed: 11/29/2022] Open
Abstract
Background Prolonged and excessive drainage of serous fluid and seroma formation constitute the most common complications after mastectomy for breast carcinoma. Seroma formation delays wound healing, increases susceptibility to infection, skin flap necrosis, persistent pain and prolongs convalescence. For this, several techniques have been investigated to improve primary healing and minimize seroma formation. Materials and methods Between June 2009 and July 2010 forty patients with breast carcinoma, scheduled for modified radical mastectomy, were randomly divided into 2 groups, the study group (20) and the control group (20). In the study group; the mastectomy flaps were fixed to the underlying muscles in raws, at various parts of the flap and at the wound edge using fine absorbable sutures. In the control group; the wound was closed in the conventional method at the edges. Closed suction drains were used in both groups. Patients, tumor characteristics and operative related factors were recorded. The amount and color of drained fluid were recorded daily. The drains were removed when the amount become less than 50 cc. The total amount and duration of drained fluid and the formation of seroma were recorded and the results were compared between the two groups. Results In the flap fixation group, the drain was removed in significantly shorter time compared to the control group (p < 0.001). Also, the total amount of fluid drained was significantly lower in the flap fixation group (p < 0.001). The flap fixation group showed a significantly lower frequency of seroma formation compared to the control group, both clinically (p = 0.028) and ultrasonographically (p = 0.047). Conclusions The mastectomy flap fixation technique is a valuable procedure that significantly decreases the incidence of seroma formation, and reduces the duration and amount of drained fluid. However, it should be tried on a much wider scale to prove its validity.
Collapse
|
15
|
Amsellem P. Complications of Reconstructive Surgery in Companion Animals. Vet Clin North Am Small Anim Pract 2011; 41:995-1006. vii. [DOI: 10.1016/j.cvsm.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
16
|
Brar P, Jain S, Singh I. Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS. Indian J Surg Oncol 2011; 2:126-32. [PMID: 22693405 DOI: 10.1007/s13193-011-0078-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 07/11/2011] [Indexed: 11/26/2022] Open
Abstract
ALND is part of primary management of breast cancer. In spite of complications it causes, its use in prognostication and planning adjuvant treatment in carcinoma breast is unquestioned. Prospective study was conducted on 100 patients of EBC [clinical stage I&II]. 50 underwent MRM, 50 WLE&AC. Patients were asked to rate on likert scale various symptoms on follow up. Multivariate regression analysis was carried out between pain, numbness, limitation of shoulder or arm motion, arm swelling, infection and age, BSA, clinical status of axilla, no. of LNs removed, no. of positive LNs, co-morbidities, chemotherapy, radiotherapy, hormone therapy, type of surgery. 60% patients reported one or more symptoms. Numbness, pain were reported by 39% each, arm swelling by 25%, limitation of arm movement by 16%, infection by 11%. Symptoms were mild in majority. On regression analyses numbness was associated with EBRT, co-morbidity, type of operation (p value- <0.01, <0.01, <0.05), pain had no significant association, swelling with EBRT, no. of LNs positive for metastases, co-morbidity, type of operation (p value- <0.01, <0.05, <0.05, <0.01), limitation of arm motion with no. of positive LNs (p value < 0.01), infection with no. of positive LNs, co-morbidity (p value <0.05, <0.05). There was no statistically significant difference in reporting of symptoms by patients in two groups. ALND caused morbidity in majority of patients but few reported severe symptoms and interference with daily activities.
Collapse
|
17
|
Khoder WY, Trottmann M, Buchner A, Stuber A, Hoffmann S, Stief CG, Becker AJ. Risk factors for pelvic lymphoceles post-radical prostatectomy. Int J Urol 2011; 18:638-43. [PMID: 21689165 DOI: 10.1111/j.1442-2042.2011.02797.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lymphoceles (LC) represent a well-described rare complication post-radical prostatectomy (RP). Our aim was to determine risk factors and to develop possible prevention strategies for LC in a community-based study. METHODS Data from 1163 RP-patients from 67 clinics between January 2002 and December 2004 were retrospectively evaluated. Patients underwent pelvic imaging procedures/LC-management during 3 weeks of rehabilitation post-RP. RESULTS LC were identified in 304 patients (26%). Lymphadenectomy was carried out in 92% of patients (1001/1086 patients), from which 28% had LC (n = 277) versus 14% without lymphadenectomy (12/85, P = 0.007). Complications (lower limb edema, pain, thrombosis, infection and bladder compression) were observed in 9% of patients (28/304; 2.4% of total patients); necessitating therapy. LC therapy was carried out in 59 patients (5.9%) with pelvic lymph node dissection (PLND) and in no patients (0%) without PLND (P = 0.021). Risk factors included were patients' age, body mass index, prostate volume, TNM-classification, number of removed lymph nodes, previous surgery/therapy, heparin prophylaxis, surgical instruments and pelvic lymphadenectomy. Univariate analysis showed lymphadenectomy as the only significant risk factor for the development of LC post-RP (P = 0.007). When applying multivariate analyses using stepwise logistic regression, only lymphadenectomy was associated with a significant risk for lymphoceles (odds ratio = 2.6, 95% CI = 1.3-4.9, P = 0.004). Adjusting for other factors, no other factor came close to being significant (P < 0.05). All symptomatic LC were successfully treated without further sequelae. CONCLUSIONS Subclinical LC post-RP are more common than thought, and rarely necessitate intervention. Pelvic lymphadenectomy represents the only significant factor contributing to LC-development. Because of this, prevention remains difficult.
Collapse
Affiliation(s)
- Wael Y Khoder
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
18
|
McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev 2010:CD005211. [PMID: 20556760 DOI: 10.1002/14651858.cd005211.pub2] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Upper-limb dysfunction is a commonly reported side effect of treatment for breast cancer and may include decreased shoulder range of motion (the range through which a joint can be moved) (ROM) and strength, pain and lymphedema. OBJECTIVES To review randomized controlled trials (RCTs) evaluating the effectiveness of exercise interventions in preventing, minimi sing, or improving upper-limb dysfunction due to breast cancer treatment. SEARCH STRATEGY We searched the Specialised Register of the Cochrane Breast Cancer Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008); contacted experts, handsearched reference lists, conference proceedings, clinical practice guidelines and other unpublished literature sources. SELECTION CRITERIA RCTs evaluating the effectiveness and safety of exercise for upper-limb dysfunction. DATA COLLECTION AND ANALYSIS Two authors independently performed the data abstraction. Investigators were contacted for missing data. MAIN RESULTS We included 24 studies involving 2132 participants. Ten of the 24 were considered of adequate methodological quality.Ten studies examined the effect of early versus delayed implementation of post-operative exercise. Implementing early exercise was more effective than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6); however, early exercise also resulted in a statistically significant increase in wound drainage volume (Standardized Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI: 0.65 to 1.65).Fourteen studies examined the effect of structured exercise compared to usual care/comparison. Of these, six were post-operative, three during adjuvant treatment and five following cancer treatment. Structured exercise programs in the post-operative period significantly improved shoulder flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16). Physical therapy treatment yielded additional benefit for shoulder function post-intervention (SMD: 0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There was no evidence of increased risk of lymphedema from exercise at any time point. AUTHORS' CONCLUSIONS Exercise can result in a significant and clinically meaningful improvement in shoulder ROM in women with breast cancer. In the post-operative period, consideration should be given to early implementation of exercises, although this approach may need to be carefully weighed against the potential for increases in wound drainage volume and duration. High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and address persistent upper-limb dysfunction are needed.
Collapse
Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall, Edmonton, Alberta, Canada, T6G 2G4
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Zawaneh PN, Putnam D. Materials in Surgery: A Review of Biomaterials in Postsurgical Tissue Adhesion and Seroma Prevention. TISSUE ENGINEERING PART B-REVIEWS 2008; 14:377-91. [DOI: 10.1089/ten.teb.2008.0226] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Peter N. Zawaneh
- School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York
| | - David Putnam
- School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York
- Department of Biomedical Engineering, Cornell University, Ithaca, New York
| |
Collapse
|
20
|
Effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer. Am J Surg 2008; 196:170-4. [PMID: 18639659 DOI: 10.1016/j.amjsurg.2007.09.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 09/07/2007] [Accepted: 09/07/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15% to 85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results. METHODS Fifty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray and a collagen patch were applied to the axillary fossa in 25 patients; the other 25 patients were treated conventionally. RESULTS Suction drainage was removed between postoperative days 3 and 4. Seroma magnitude and duration were significantly reduced (P = .004 and .02, respectively) and there were fewer evacuative punctures in patients receiving fibrin glue and collagen patches compared with the conventional treatment group. CONCLUSIONS Use of fibrin glue with collagen patches does not always prevent seroma formation, but it does reduce seroma magnitude and duration, as well as necessary evacuative punctures.
Collapse
|
21
|
Abstract
The aim of this prospective study was to investigate the effects of early onset rehabilitation program on shoulder mobility, functional status, lymphedema, and the incidence of postoperative complications in patients who had modified radical mastectomy. Fifty-seven women were randomly assigned to either treatment group or home exercise program groups, which were consisted of 27 and 30 patients, respectively. After removal of the drains, the patients were instructed to 15 sessions of individual rehabilitation program and continued with home-based physical activity program. The home exercise program groups only received a form including the exercises, which could be performed by themselves after removal of the drains. Range of motion of the shoulder joint and upper extremity circumferential difference were measured. Functional status was assessed by functional index score. Each patient was assessed preoperatively and then postoperatively at fifth day and first, third, and sixth months. The improvement in measurements of flexion, abduction, and adduction movements of the shoulder joint and the functional questionnaire scores were significantly better in treatment group. There was no statistically significant difference in the development of lymphedema and postoperative complications in both groups. Early onset rehabilitation program after modified radical mastectomy provides improvement in shoulder mobility and functional capacity without causing adverse effect in postoperative period.
Collapse
|
22
|
Chung TL, Holton LH, Goldberg NH, Silverman RP. Seroma prevention using Mytilus edulis protein in a rat mastectomy model. Breast J 2008; 12:442-5. [PMID: 16958963 DOI: 10.1111/j.1075-122x.2006.00300.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Seroma formation is common following mastectomy and autologous breast reconstruction and is a potential cause of significant morbidity in patients. For this reason, many methods have been investigated to prevent this complication. BD Cell-Tak is a tissue adhesive formulated from the proteins excreted by the marine mussel Mytilus edulis. The purpose of this study was to determine if Cell-Tak is able to prevent seroma formation in a rat mastectomy seroma model. Twenty Sprague-Dawley rats underwent unilateral radical mastectomy, partial axillary lymph node dissection, and disruption of the dermal lymphatics. The animals were randomly assigned to either control (n = 10) or experimental groups (n = 10). The experimental animals received 0.3 ml of the topical adhesive in the wound prior to closure, whereas control animals received no treatment. On postoperative day 7, seroma collections were aspirated and quantified and the tissue flaps were sent for histologic analysis. The control rats had a mean seroma volume of 5.3 +/- 2.6 ml, whereas the rats treated with Cell-Tak tissue adhesive had a mean seroma volume of 1.8 +/- 1.5 ml (p < 0.004). Histologic analysis revealed mild inflammation consistent with postoperative changes in both groups and no evidence of foreign body reaction to the adhesive. BD Cell-Tak tissue adhesive significantly reduces seroma formation in the rat mastectomy model. This tissue adhesive may prove beneficial in patients undergoing mastectomy with or without breast reconstruction.
Collapse
Affiliation(s)
- Thomas L Chung
- Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | | | | | | |
Collapse
|
23
|
Abstract
Impairments and disability in cancer patients can be caused by the disease process or by its treatment, including the effects of surgery, chemotherapy, and radiation. The prevalence of all cancers, with an estimated 1.4 million new cases in 2006, the development of new treatment options, and improved outcomes have created a constantly growing population of cancer survivors whose function and quality of life have been affected by their diagnoses. This article reviews the theoretical framework, clinical interventions, and research initiatives pertinent to providing rehabilitation services for patients who have been diagnosed with cancer.
Collapse
|
24
|
Antonio M, Pietra T, Domenico L, Massimo D, Ignazio R, Antonio N, Luigi C. Does LigaSure reduce fluid drainage in axillary dissection? A randomized prospective clinical trial. Ecancermedicalscience 2007; 1:61. [PMID: 22275958 PMCID: PMC3223974 DOI: 10.3332/ecms.2007.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Indexed: 11/29/2022] Open
Abstract
Background: Axillary lymph node dissection (ALND) is an integral part of breast cancer treatment. It is required in about 40–50% of patients. The placement of a drain in the axilla after an operation is current surgical practice. Short surgical stay programmes increase operating efficiency and reduce medical care costs, without compromising quality of care. LigaSure™ is a new haemostatic device that uses bipolar energy to seal vessels. The aim of this study is to determine whether axillary dissection with LigaSure™ reduces the time of wound drainage, the duration of surgical intervention and the volume of drainage after treatment. Patients and methods: This study is a prospective randomized controlled trial. A total of 100 women with breast cancer who needed axillary dissection were randomized into the LigaSure™ or conventional axillary dissection group. Levels I to III lymph node dissection was performed. A closed suction drain was always placed in the axilla and removed after 6–8 days or when fluid amount was <60 cc in the previous 24 hours. Results: There were no significant differences between the two groups when considering the duration of surgical procedure: average duration was 70.7 ± 24.66 minutes for LigaSure™ patients, while in the conventional dissection group the mean was 70.6 ± 22.47 minutes (p=0.98). Total amount of drained fluid was 624.49 cc in the LigaSure™ axillary dissection group and 792.96 in the conventional ALND group; this difference did not achieve statistical significance (p=0.09); the duration of draining was also similar, with no statistical difference (p=0.15). Conclusions: The present study did not show clear advantages in LigaSure™ use for ALND, although it represents a good haemostatic device, especially in abdominal surgery.
Collapse
Affiliation(s)
- M Antonio
- Department of Experimental Oncology and Clinical Application, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | |
Collapse
|
25
|
Loo WTY, Sasano H, Chow LWC. Pro-inflammatory cytokine, matrix metalloproteinases and TIMP-1 are involved in wound healing after mastectomy in invasive breast cancer patients. Biomed Pharmacother 2007; 61:548-52. [PMID: 17904786 DOI: 10.1016/j.biopha.2007.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mastectomy provides a good model to study the wound healing process after surgery. The involved factors include selectins, pro-inflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), matrix metalloproteinases (MMPs), and their natural inhibitors (TIMPs). In the present study, we observed the kinetic changes of these factors in the process of wound healing after a mastectomy, and analyzed the relationship between these factors and the clinical outcomes. MATERIALS AND METHODS Twenty-nine patients, who received a modified radical mastectomy, were recruited to this study. The wound was inspected daily for the presence of flap necrosis, infection and seroma. Drain fluid was collected on days 1, 2 and 5. IL-6, P-selectin, MMP-2, 3, 9 and TIMP-1 were screened by ELISA kits for their impacts on wound healing after mastectomy. RESULTS IL-6 demonstrated the highest level on Day 1 after operation and was negatively correlated with MMP-2, which in turn showed a consistently negative correlation with MMP-9 for days 1, 2 and 5. Incidences of seroma formation and skin flap necrosis were 27.6% and 20.7%, respectively. Seroma formation was associated with low MMP-2 levels on Day 5. While skin flap necrosis seemed to correlate with high MMP-2 levels and low levels of MMP-9 and TIMP-1. CONCLUSION IL-6, P-selectin, MMP-2, MMP-3, MMP-9 and TIMP-1 are important in the process of wound healing after mastectomy. A low MMP-2 level correlates with the formation of seroma, while MMP-2, MMP-9 and TIMP-1 are associated with skin flap necrosis.
Collapse
Affiliation(s)
- Wings T Y Loo
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | | | | |
Collapse
|
26
|
Kilgour RD, Jones DH, Keyserlingk JR. Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study. Breast Cancer Res Treat 2007; 109:285-95. [PMID: 17624606 DOI: 10.1007/s10549-007-9649-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 06/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This pilot study examined the effects of a self-administered, home-based exercise (HBE) rehabilitation programme designed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection. METHODS Twenty-seven women who were scheduled for surgery were randomly assigned to either a post-surgical experimental HBE rehabilitation group (n = 16) or a usual care group (UC; n = 11). Women assigned to the HBE group followed an 11 day (days 3-14 post-surgery), home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape. The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society. RESULTS As a result of the exercise programme intervention, there was a time x group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion (ROM) (p = 0.003) and abduction ROM (p = 0.036) when compared to the UC. There were no statistical differences in shoulder strength between groups over time. External rotation (p = 0.036) and grip strength (p = 0.001) significantly increased in both groups during the intervention period but there were no interaction effects. With respect to the forearm circumferences, there was a significant decrease over time (p < 0.001) but no interaction between groups. CONCLUSION This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery.
Collapse
Affiliation(s)
- Robert D Kilgour
- Department of Exercise Science, The Richard J. Renaud Science Complex, Concordia University, Montreal, QC, Canada.
| | | | | |
Collapse
|
27
|
Abstract
BACKGROUND Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined. METHOD MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out. RESULT The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive. CONCLUSION Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.
Collapse
Affiliation(s)
- Amit Agrawal
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, UK
| | | | | |
Collapse
|
28
|
Barton A, Blitz M, Callahan D, Yakimets W, Adams D, Dabbs K. Early removal of postmastectomy drains is not beneficial: results from a halted randomized controlled trial. Am J Surg 2006; 191:652-6. [PMID: 16647354 DOI: 10.1016/j.amjsurg.2006.01.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 01/17/2006] [Accepted: 01/17/2006] [Indexed: 01/29/2023]
Abstract
BACKGROUND Closed-suction drainage to reduce seromas is standard after mastectomy. This study evaluates the safety of early drain removal. METHODS Women undergoing mastectomy were randomized to early removal on postoperative day 2 or standard removal (< 30 mL drainage in 24 hours or postoperative day 14). Primary endpoints were time to drain removal and physician visits. Secondary endpoints were number of seroma aspirations, drain reinsertions, and infections. RESULTS Twenty-seven patients were recruited before an interim analysis was performed to address safety concerns. Three patients withdrew before trial completion, leaving 14 patients in the standard group and 10 in the early group. Patients in the standard group had significantly fewer seroma aspirations, fewer drain reinsertions, and fewer physician visits. The trial was halted because of the higher rate of events in the early group. CONCLUSION Surgical drains cannot be safely removed on postoperative day 2 after mastectomy. Early removal significantly increases the occurrence of seromas requiring treatment.
Collapse
Affiliation(s)
- Anise Barton
- Department of Surgery, Misericordia Hospital, University of Alberta, 16940 87 Ave, Edmonton, Alberta T5R 4H5, Canada
| | | | | | | | | | | |
Collapse
|
29
|
Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, Saito S. Evidence-Based Risk Factors for Seroma Formation in Breast Surgery. Jpn J Clin Oncol 2006; 36:197-206. [PMID: 16684859 DOI: 10.1093/jjco/hyl019] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Seroma is a common problem in breast surgery. The aim of this systematic review was to identify risk factors for seroma formation. METHODS Articles published in English were obtained from searches of Medline and additional references were found in the bibliographies of these articles. Risk factors were graded according to the quality and strength of evidence and to the direction of association. RESULTS One meta-analysis, 51 randomized controlled trials, 7 prospective studies and 7 retrospective studies were identified. There was no risk factor supported by strong evidence, but there was moderate evidence to support a risk for seroma formation in individuals with heavier body weight, extended radical mastectomy as compared with simple mastectomy, and greater drainage volume in the initial 3 days. On the other hand, the following factors did not have a significant influence on seroma formation: duration of drainage; hormone receptor status; immobilization of the shoulder; intensity of negative suction pressure; lymph node status or lymph node positivity; number of drains; number of removed lymph nodes; previous biopsy; removal of drains on the fifth postoperative day versus when daily drainage volume fell to minimal; stage; type of drainage (closed suction versus static drainage); and use of fibrinolysis inhibitor. In contrast, sentinel lymph node biopsy reduced seroma formation. Evidence was weak, or unproven, for other factors that were commonly cited in the literature. CONCLUSIONS Although a number of factors have been correlated with seroma formation, strong evidence is still scarce. However, there is evidence showing that sentinel lymph node biopsy reduces seroma formation.
Collapse
Affiliation(s)
- Katsumasa Kuroi
- Division of Surgery and Breast Oncology, Nyuwakai Oikawa Hospital, 2-21-16 Hirao, Chuo-ku, Fukuoka 810-0014, Japan.
| | | | | | | | | | | | | |
Collapse
|
30
|
Baas-Vrancken Peeters MJTFD, Kluit AB, Merkus JWS, Breslau PJ. Short versus long-term postoperative drainage of the axilla after axillary lymph node dissection. A prospective randomized study. Breast Cancer Res Treat 2005; 93:271-5. [PMID: 16172795 DOI: 10.1007/s10549-005-5348-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Axillary lymph node dissection (ALND) is a standard procedure in the treatment of breast cancer. Current practice following ALND involves several days of drainage of the axilla to reduce the formation of seroma. The aim of this study is to investigate the feasibility of 24 h drainage. STUDY DESIGN A prospective randomized trial was performed comparing 24 h drainage to long-term drainage. The primary outcome measure was duration of hospital stay. Formation of seroma and wound related complications were secondary outcome measures. RESULTS Fifty patients were randomised to the 24 h drainage group and 50 patients to the long-term drainage group. 24 h drainage was associated with a shorter hospital stay (2.5 versus 4.6 days, p < 0.001). Seroma aspiration was required in 76% of the patients after 24 h drainage and in 64% after long-term drainage (p = 0.19). The number of wound related complications was higher after long-term drainage (13 versus 9, p = 0.33). Infectious complications were seen in 11 patients after long-term drainage versus 6 after 24 h drainage (p = 0.18). CONCLUSION These results indicate that 24 h drainage following ALND is feasible and facilitates early hospital discharge. Furthermore, 24 h drainage is not associated with excess wound related complications compared to long-term drainage.
Collapse
|
31
|
Jung JI, Kim HH, Park SH, Song SW, Chung MH, Kim HS, Kim KJ, Ahn MI, Seo SB, Hahn ST. Thoracic manifestations of breast cancer and its therapy. Radiographics 2005; 24:1269-85. [PMID: 15371608 DOI: 10.1148/rg.245035062] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4-12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.
Collapse
Affiliation(s)
- Jung Im Jung
- Department of Radiology, St Mary's Hospital, College of Medicine, Catholic University of Korea, 62 Yeouido-dong, Youngdungpo-gu, Seoul 150-713, South Korea.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Todd J, Topping A. A survey of written information on the use of post-operative exercises after breast cancer surgery. Physiotherapy 2005. [DOI: 10.1016/j.physio.2004.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Johnson L, Cusick TE, Helmer SD, Osland JS. Influence of fibrin glue on seroma formation after breast surgery. Am J Surg 2005; 189:319-23. [PMID: 15792759 DOI: 10.1016/j.amjsurg.2005.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 11/22/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study was designed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures. METHODS A prospective, randomized, controlled study of subjects who were randomized into control (drain) and experimental (fibrin) groups was conducted. RESULTS Analysis of 82 patients showed similarly matched groups. Seroma formation rate was 45.5% in the control group and 36.8% in the fibrin glue group (P = 0.43). The rate of wound complications was similar. Aspirate volumes were significantly greater in the fibrin glue group. Drain placement saved patients >366 US dollars over fibrin glue. CONCLUSIONS Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost involved, cumbersome technique, and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.
Collapse
Affiliation(s)
- LyNette Johnson
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS 67214, USA
| | | | | | | |
Collapse
|
34
|
Shamley DR, Barker K, Simonite V, Beardshaw A. Delayed versus immediate exercises following surgery for breast cancer: a systematic review. Breast Cancer Res Treat 2005; 90:263-71. [PMID: 15830140 DOI: 10.1007/s10549-004-4727-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Seroma formation, wound healing and fluid drainage are a concern for both surgeons and patients. Excessive fluid production can result in seroma formation, and inadequate drainage of seromas is known to cause infection, pain, discomfort and longer periods of hospitalisation. Postoperative exercises given to maintain movement of the arm are believed to increase the amount of fluid production following surgery. This review aimed to determine whether a program of delayed exercises reduces the risk of seroma formation, fluid loss and hospital stay, without loss of arm movement. METHOD A systematic review. RCTs of early versus delayed shoulder mobilisation after surgery in females with breast cancer were included in the review. Outcomes. One or more measurements of shoulder range of motion, wound complications, fluid drainage volumes and incidence of seroma formation. Design. Randomised controlled trials, control group of delayed exercise/mobilisation. Validity assessment was carried out using a data extraction form based on the CONSORT statement. Study characteristics recorded include sample size, intervention, control, period of exercise delay, surgical procedure and conclusions drawn. Data synthesis was carried out using random effects and weighted mean differences to test for heterogeneity and combined effects. RESULTS 12 RCTs were included in the review of which 6 were included for meta-analysis. Delaying exercises significantly decreases seroma formation (OR=0.4; 95%CI 0.2-0.5; p=0.00001). No significant differences were found for drainage volume or hospital stay. CONCLUSION Current evidence from RCTs supports the use of a delayed program of arm exercises to reduce seroma formation. Clinical and statistical inconsistencies between studies did not allow any conclusions to be drawn regarding the effects of delayed exercises on fluid drainage, hospital stay and immediate or long term ability to move the arm.
Collapse
Affiliation(s)
- Delva R Shamley
- Oxford Radcliffe Hospitals Trust Charity Programme Lead, Physiotherapy, School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston OX3 OFL, UK.
| | | | | | | |
Collapse
|
35
|
Singhal V, Singh JP, Bansal A, Saxena S. Half versus full vacuum suction drainage after modified radical mastectomy for breast cancer- a prospective randomized clinical trial[ISRCTN24484328]. BMC Cancer 2005; 5:11. [PMID: 15676064 PMCID: PMC548268 DOI: 10.1186/1471-2407-5-11] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2004] [Accepted: 01/27/2005] [Indexed: 11/26/2022] Open
Abstract
Background Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of postoperative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. While a high negative suction pressure is expected to drain the collection and reduce the dead space promptly, it may also prevent the leaking lymphatics from closing and lead to increased drainage from the wound. Against this background a prospective randomized clinical study was conducted to compare the amount and duration of drainage between a half negative suction and full vacuum suction drainage in patients following modified radical mastectomy. The associated postoperative morbidity was also compared between the two groups. Methods 85 FNAC (fine needle aspiration cytology) proven cases of locally advanced breast cancer were randomized. (Using randomly ordered sealed envelops, which were opened immediately before the closure of the wound) in to 50 patients with full vacuum suction (pressure = 700 g/m2) and 35 cases in to half vacuum suction drainage (pressure = 350 g/m2) groups. The two groups were comparable in respect of age, weight, and technique of operation and extent of axillary dissection. Surgery was performed by the same surgical team comprising of five surgeons (two senior and three resident surgeons) using a standardized technique with electrocautery. External compression dressing was provided over the axilla for first 48 hrs and following that patients were encouraged to do active and passive shoulder exercises. The outcomes measured were postoperative morbidity and the length of hospital stay. Statistical methods used: Descriptive studies were performed with SPSS version 10 and group characteristics were compared using student t-test. Results Half vacuum suction drains were removed earlier than the full suction vacuum suction drains. There was no significant difference in the incidence of seroma formation in the two groups and there was a significant reduction in the total hospital stay in patients with half vacuum suction drainage systems as compared to the full suction drainage group (p < 0.001) without any added morbidity. Conclusions Half negative suction drains provide an effective compromise between no suction and full or high suction drainage after modified radical mastectomy by reducing the hospital stay and the post operative morbidity including post operative seromas.
Collapse
Affiliation(s)
- Vinay Singhal
- Department of Surgery, Vardhman Mahavir Medical College Safdarjang Hospital New Delhi – India
- Vardhman Mahavir Medical College Safdarjang Hospital New Delhi-110023 – India
| | - JP Singh
- Department of Surgery, Vardhman Mahavir Medical College Safdarjang Hospital New Delhi – India
- Vardhman Mahavir Medical College Safdarjang Hospital New Delhi-110023 – India
| | - Anju Bansal
- Vardhman Mahavir Medical College Safdarjang Hospital New Delhi-110023 – India
- Tumor Biology Lab Indian Council Of Medical Research (ICMR) New Delhi – India
| | - Sunita Saxena
- Vardhman Mahavir Medical College Safdarjang Hospital New Delhi-110023 – India
- Tumor Biology Lab Indian Council Of Medical Research (ICMR) New Delhi – India
| |
Collapse
|
36
|
Hashemi E, Kaviani A, Najafi M, Ebrahimi M, Hooshmand H, Montazeri A. Seroma formation after surgery for breast cancer. World J Surg Oncol 2004; 2:44. [PMID: 15588301 PMCID: PMC543447 DOI: 10.1186/1477-7819-2-44] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 12/09/2004] [Indexed: 11/29/2022] Open
Abstract
Background Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. Patients and methods A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. Results A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. Conclusion The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.
Collapse
Affiliation(s)
| | - Ahmad Kaviani
- Tehran University of Medical Sciences, Faculty of Medicine, Department of Surgery, Tehran, Iran
| | | | | | | | | |
Collapse
|
37
|
Rietman JS, Dijkstra PU, Debreczeni R, Geertzen JHB, Robinson DPH, De Vries J. Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery. Disabil Rehabil 2004; 26:78-84. [PMID: 14668143 DOI: 10.1080/09638280310001629642] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to assess impairments, disabilities and health related Quality of Life (QOL) after treatment of breast cancer and to analyse the relationship between treatment modalities, impairments, disabilities and health related QOL. METHOD Fifty-five patients who underwent a modified radical mastectomy or a segmental mastectomy with axillary lymph node dissection were retrospectively assessed with a mean follow up of 2.7 years after treatment. Impairments were assessed by means of measuring active shoulder range of motion, grip strength, arm volume and pain. Disabilities were assessed by means of the Shoulder Disability Questionnaire (SDQ) and health related QOL was assessed by means of the RAND 36-item Health Survey (RAND-36). SETTING University Hospital Groningen (The Netherlands). RESULTS Pain (60%) and reduction of grip-strength (40%) were the most frequent impairments found. The prevalence of impaired range of motion and oedema was 9 - 16% respectively 15%. Mean group score of the SDQ was 33.7 (sd: 32.1) and mean scores of the RAND-36 differed significantly for physical functioning, vitality and health perception to that of a female norm group. Radiotherapy and chemotherapy were significant factors in the prediction of impaired range of motion. Pain and restricted range of motion explained 61% respectively 12% of the variance in disability (SDQ). In the prediction of health related QOL, pain, grip strength and arm volume were significant factors respectively in six, three and two domains. CONCLUSIONS Pain is the most frequent assessed impairment after breast cancer treatment with strong relationship to perceived disability and health related QOL. Disability is mild and health related QOL (RAND-36) differed in three of the nine domains with a female norm group.
Collapse
Affiliation(s)
- Johan S Rietman
- Department of Rehabilitation Medicine, University Hospital Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
38
|
Bendz I, Fagevik Olsén M. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection--a randomised controlled trial. Breast 2004; 11:241-8. [PMID: 14965674 DOI: 10.1054/brst.2001.0412] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2001] [Revised: 10/04/2001] [Accepted: 10/08/2001] [Indexed: 11/18/2022] Open
Abstract
Two hundred and thirty women who had undergone surgery for breast cancer were randomised to a prospective study, comparing early (group A) and delayed (group B) shoulder exercise. Preoperatively, group A received instructions and an exercise programme supervised by a physiotherapist, whereas group B received written instructions to use the arm normally but to avoid heavy work. Two weeks after surgery both groups were given identical exercise programmes. Shoulder mobility, hand strength and arm volume were measured preoperatively, 1 month, 6 months and 2 years postoperatively. After 2 years 13.8% of the women had lymphoedema, but there were no significant differences between the groups. Grip strength was slightly decreased during the postoperative period in both groups (n.s.). Postoperatively, all movements in both groups were decreased after 2 weeks and 1 month and shoulder elevation and abduction remained decreased at 2 years. Mobility in group A recovered significantly earlier than in group B.
Collapse
Affiliation(s)
- I Bendz
- Sjukgymnastiken, SU/Sahlgrenska, S-413 45 Göteborg, Sweden
| | | |
Collapse
|
39
|
Jain PK, Sowdi R, Anderson ADG, MacFie J. Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 2004; 91:54-60. [PMID: 14716794 DOI: 10.1002/bjs.4435] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite limited evidence, closed suction drainage is often used to reduce the risk of seroma formation after breast cancer surgery. The aim of this study was to evaluate the effect of drains and fibrin sealant on the incidence of seroma formation. METHODS A total of 116 patients undergoing surgery for breast cancer were randomized to receive suction drainage (group 1; n = 58), or to receive no drain (n = 58). Patients allocated to receive no drain were further randomized to have fibrin sealant applied to the dissected area (group 2; n = 29), or to no intervention (group 3; n = 29). Outcome measures were incidence and volume of postoperative seroma, length of hospital stay and postoperative pain scores. RESULTS There was no significant difference in the incidence of seroma between group 1 (15 of 58) and either group with no drains (ten of 29 in group 2; 12 of 29 in group 3). There was a significant reduction in hospital stay and postoperative pain scores in patients who did not have a drain. Following mastectomy without a drain, the use of fibrin sealant was associated with a significant reduction in the incidence and total volume of seroma (190 versus 395 ml; P = 0.012). CONCLUSION Drains did not prevent seroma formation, and were associated with a longer postoperative stay and higher pain scores after surgery for breast cancer. In patients who had mastectomy the use of fibrin sealant reduced the rate of seroma formation.
Collapse
Affiliation(s)
- P K Jain
- Department of Surgery, Scarborough General Hospital, Woodland Drive, Scarborough YO12 6QL, UK
| | | | | | | |
Collapse
|
40
|
Lumachi F, Burelli P, Basso SM, Iacobone M, Ermani M. Usefulness of Ultrasound Scissors in Reducing Serous Drainage after Axillary Dissection for Breast Cancer: A Prospective Randomized Clinical Study. Am Surg 2004. [DOI: 10.1177/000313480407000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Axillary dissection is usually associated with prolonged serous drainage that may result in several complications. We analyzed whether the use of ultrasound scissors may decrease the total amount of drainage from the axilla (AD) in patients requiring curative surgery for breast cancer. Seventy-six women (median age, 56 years; range, 32–73 years) with confirmed pT1–3, N0–1 breast cancer were prospectively randomly assigned to undergo mastectomy or breast-conserving surgery with axillary dissection by either using (group A) or not using (group B) ultrasound scissors. Overall, there was a linear relationship ( P < 0.05) between AD and both total number of the removed nodes and body mass index, whereas no correlation ( P = NS) was found with age and size of the tumor. Total AD was higher (492 ± 153 vs. 408 ± 136 mL, P = 0.013) in group B, whereas the postoperative hospital stay was shorter (2.4 ± 0.6 vs. 2.7 ± 0.7 days, P = NS) in group A. The three-way analysis of covariance using the number of total removed nodes as covariate showed that lymph node status, type of operation, and technique for axillary dissection significantly ( P < 0.05) correlated with AD. In conclusion, our initial study shows that the use of ultrasound scissors significantly reduced total AD in patients requiring axillary dissection and may shorten hospital stay.
Collapse
Affiliation(s)
- Franco Lumachi
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Paolo Burelli
- Unita Operativa di Chirurgia, Azienda Ospedaliera, Conegliano, Italy
| | - Stefano M.M. Basso
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy
| | - Mario Ermani
- Section of Biostatistics, Department of Neurosciences, University of Padua, School of Medicine, Padova, Italy
| |
Collapse
|
41
|
Morimoto T, Tamura A, Ichihara T, Minakawa T, Kuwamura Y, Miki Y, Sasa M. Evaluation of a new rehabilitation program for postoperative patients with breast cancer. Nurs Health Sci 2003; 5:275-82. [PMID: 14622379 DOI: 10.1046/j.1442-2018.2003.00163.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was to evaluate the efficacy of a newly designed rehabilitation program for postoperative patients with breast cancer. This was achieved through examinations to clarify the range of motion (ROM) of the shoulder joint, postoperative pain and recovery of activities of daily living (ADL). The ROM of the shoulder joint was evaluated with respect to five items and determinations were carried out five times. Patients were orally questioned four times regarding their pain after surgery, movement-associated chest pain, pain at night and operative wound pain. Evaluation of the ADL after discharge was conducted using a three-level rating method at postoperative week 4 and week 12. A total of 72 patients were studied, comprising 39 who underwent pectoral muscle-conserving mastectomy and 33 who underwent breast-conserving surgery. The arm movement of forward raising showed the greatest decline, followed by lateral raising of the arm. Postoperative time-course changes in internal/external arm rotation, as well as backward arm raising were slight. Comparison of the operative procedures revealed differences only for lateral arm raising at postoperative week 4, while there were no differences in any of the shoulder joint movements. Lowering of the ROM of the shoulder joint was more marked at an earlier time (week 1 to week 2) after surgery, but it was not statistically significant. Pain at night and operative wound pain were prolonged over the period, and reported in postoperative week 1 to week 12 by 3-15% of patients. All ADL items became almost normal in approximately 90% of patients at postoperative week 4. The efficacy of the present rehabilitation program early after surgery was demonstrated in terms of recovery of ADL as well as the ROM of the arm on the affected side.
Collapse
Affiliation(s)
- Tadaoki Morimoto
- Department of Adult and Gerontological Nursing, School of Health Sciences, University of Tokushima, Tokushima, Japan.
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Seroma is a common problem following breast cancer surgery causing patient discomfort and prolongation of hospital stay. METHODS This manuscript reviews the relevant literature obtained by an extensive search of the medline database. In addition papers were also derived from the reference lists of retrieved articles. RESULTS AND CONCLUSION The advantages and disadvantages of the various methods to deal with seroma are discussed. Based on this an individual patient based policy can be formulated.
Collapse
Affiliation(s)
- C J Pogson
- Breast Unit, Mayday University Hospital, London Road, Croydon CR7 7YE, UK
| | | | | |
Collapse
|
43
|
Abstract
Seromas and prolonged, excessive drainage of serous fluid constitute the most common complications of mastectomy for breast carcinoma. The pathogenesis of this drainage problem is analysed from a pathological perspective and encompasses the role of biomechanical stresses involved in healing. Closed suction drainage delays healing and contributes to the accumulation of serum fluid in the wound. Suction of air into the patient's wound potentiates chronic drainage and seroma formation, adding to patient discomfort and increased risk of infection. The principle of primary union of the wound should be reinstated in mastectomies and to this end relevant changes in the surgical and postoperative management are proposed.
Collapse
|
44
|
Chow LWC, Loo WTY, Yuen KY, Cheng C. The study of cytokine dynamics at the operation site after mastectomy. Wound Repair Regen 2003; 11:326-30. [PMID: 12950635 DOI: 10.1046/j.1524-475x.2003.11503.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty-nine patients, who each received modified radical mastectomy, were recruited for this study. Wounds were inspected daily for the presence of flap necrosis, infection, and seroma. Drain fluid (20 ml) was collected at 6 a.m. on postoperative days 1, 2, and 5 and the levels of interleukin (IL)-4, IL-6, tumor necrosis factor-alpha, and interferon-gamma determined. For patients with no wound events, only IL-6 levels were elevated during the initial phase, but in the later phase the IL-6 levels dropped with a corresponding rise in tumor necrosis factor-alpha levels. In patients with flap necrosis, there was a sequential rise of IL-4 on day 1, IL-6 on day 2, and tumor necrosis factor-alpha on day 5, but only IL-4 was found to be a statistically significant factor associated with necrosis. In patients with seroma, the levels of IL-4 and interferon-gamma were persistently low and were both statistically significant. To conclude, IL-6 and tumor necrosis factor-alpha are important in normal postoperative wound healing and IL-4 and interferon-gamma may be associated with postoperative necrosis and seroma.
Collapse
Affiliation(s)
- Louis W C Chow
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong.
| | | | | | | |
Collapse
|
45
|
Ulusoy AN, Polat C, Alvur M, Kandemir B, Bulut F. Effect of fibrin glue on lymphatic drainage and on drain removal time after modified radical mastectomy: a prospective randomized study. Breast J 2003; 9:393-6. [PMID: 12968960 DOI: 10.1046/j.1524-4741.2003.09506.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seroma formation is a frequently occurring complication in patients operated on because of breast cancer. This complication can be the cause of flap necrosis, can lead to infection, and can prolong the hospital stay. It can also cause a delay in chemotherapy and radiotherapy. In order to prevent seroma formation, various methods such as external compression dressings, immobilization of the arm, sclerotherapy, and suction drainage have been used, without much success. In animal models and some clinical studies, it has been stated that fibrin glue reduces seroma formation, and these statements generated high expectations. For this reason, a prospective study was planned to test this in patients who underwent modified radical mastectomy (MRM) because of breast cancer. Of the 54 patients studied, 27 patients had fibrin glue (4 ml) applied to wound surfaces and under the flap (study group); the remaining 27 patients were the control group. Daily drainage volumes, total amount of drainage, drain removal time, and seroma formation were recorded and compared between the two groups. The first-day drainage was significantly lower in the study group (p<0.05, Student's t-test). There were no significant differences in daily drainage volumes, drain removal time, seroma formation frequency, and the number of seromas between the two groups (p>0.05). In conclusion; fibrin glue application had no significant benefit on axillary lymphatic drainage, drain removal time, or seroma formation.
Collapse
Affiliation(s)
- Ali Naki Ulusoy
- Department of Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
| | | | | | | | | |
Collapse
|
46
|
Yap KPL, McCready DR, Narod S, Manchul LA, Trudeau M, Fyles A. Factors influencing arm and axillary symptoms after treatment for node negative breast carcinoma. Cancer 2003; 97:1369-75. [PMID: 12627499 DOI: 10.1002/cncr.11218] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The purpose of the current study was to identify the factors that contribute to postoperative arm symptoms following breast conserving surgery in a well-defined cohort of node negative breast carcinoma patients. METHODS A convenience sample of 370 women >/= 50 years of age with node negative breast carcinoma who were participants in a randomized controlled trial designed to assess the need for breast radiation in addition to tamoxifen were surveyed. Axillary dissection was optional for patients 65 years or older and who were clinically node negative. RESULTS A total of 65.1% (241/370) of women had ipsilateral shoulder or arm symptoms. Multivariate analysis revealed that axillary dissection, breast radiation, and younger age (odds ratio = 11.2, 1.65, and 3.8 respectively) were significantly (P < 0.05) associated with increased ipsilateral shoulder or arm symptoms. Treatment with axillary dissection and breast radiation were significant factors (P < 0.02) associated with the self-reporting of arm swelling (odds ratio = 4.4 and 2.0, respectively). Patients 70 years old or greater reported significantly fewer arm symptoms (odds ratio = 0.26, P < 0.05) after axillary dissection. CONCLUSIONS Arm symptoms were present in about 80% of patients who underwent breast conserving surgery, axillary dissection, and breast radiation in the current study. These symptoms were significantly associated with the use of axillary dissection, breast radiation, and younger age. Older patients experienced fewer arm symptoms after standard treatment for node negative breast carcinoma, and thus older age should not be a contraindication to axillary dissection.
Collapse
Affiliation(s)
- Karen P L Yap
- Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
47
|
Kuehn T, Santjohanser C, Grab D, Klauss W, Koretz K, Kreienberg R. Endoscopic axillary surgery in breast cancer. Br J Surg 2002; 88:698-703. [PMID: 11350444 DOI: 10.1046/j.1365-2168.2001.01751.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
The aim was to provide an assessment of the current status of endoscopic axillary surgery in patients with breast cancer.
Methods
Fifty-three patients underwent endoscopic lymphadenectomy. The surgical efficiency (operating time, number of resected nodes, intraoperative and postoperative complications), short-term morbidity (duration of drainage, total lymph flow, seroma rate) and long-term outcome (pain, numbness, mobility, strength, oedema) were assessed. The incidence and severity of different arm symptoms were compared with the results of 396 patients treated with a conventional axillary procedure. Finally, all available data relating to endoscopic axillary surgery were reviewed.
Results
The operating time ranged from 60 to 150 min. A mean 17 (range 10–28) lymph nodes was resected. The extent of postoperative lymphorrhoea (mean 372 ml) and the seroma rate (eight of 34 patients) were not significantly reduced in comparison with conventional surgery. The assessment of long-term morbidity revealed fewer disturbances of sensitivity and a decreased rate of severe symptom intensity for pain, oedema and complaints related to mobility.
Conclusion
Despite excellent visualization of anatomical landmarks and improved long-term morbidity, endoscopic lymph node dissection cannot be regarded as a suitable technique for routine axillary management in breast cancer because of long operating times.
Collapse
Affiliation(s)
- T Kuehn
- Departments of Gynaecology and Obstetrics and Pathology, University of Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
48
|
Anand R, Skinner R, Dennison G, Pain JA. A prospective randomised trial of two treatments for wound seroma after breast surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:620-2. [PMID: 12359197 DOI: 10.1053/ejso.2002.1298] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Seroma formation is a recognised complication of breast surgery causing wound pain and discomfort. It was hypothesised that daily aspiration of symptomatic seromas that formed after breast surgery would encourage flap adherence to the chest wall, thereby allowing swifter resolution of seroma. METHODS Thirty-six patients undergoing mastectomy and/or axillary clearance who formed seroma post operatively, were randomised into two groups either having daily aspiration of seroma or aspiration as required by patient symptoms. RESULTS The daily aspiration required significantly more attendances for aspiration (P<0.005) and the time from surgery to final aspiration was not reduced. CONCLUSION Daily aspiration of symptomatic seroma did not result in swifter resolution.
Collapse
Affiliation(s)
- R Anand
- Poole Hospital NHS Trust, Poole BH15 2JB, Dorset, UK
| | | | | | | |
Collapse
|
49
|
Box RC, Reul-Hirche HM, Bullock-Saxton JE, Furnival CM. Shoulder movement after breast cancer surgery: results of a randomised controlled study of postoperative physiotherapy. Breast Cancer Res Treat 2002; 75:35-50. [PMID: 12500933 DOI: 10.1023/a:1016571204924] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Breast screening programmes have facilitated more conservative approaches to the surgical and radiotherapy management of women diagnosed with breast cancer. This study investigated changes in shoulder movement after surgery for primary, operable breast cancer to determine the effect of elective physiotherapy intervention. Sixty-five women were randomly assigned to either the treatment (TG) or control group (CG) and assessments were completed preoperatively, at day 5 and at 1 month, 3, 6, 12 and 24 months postoperatively. The CG only received an exercise instruction booklet in comparison to the TG who received the Physiotherapy Management Care Plan (PMCP). Analyses of variance revealed that abduction returned to preoperative levels more quickly in the TG than in the CG. The TG women had 14 degrees more abduction at 3 months and 7 degrees at 24 months. Functional recovery at 1 month was greater in those randomised to the TG, with a dominant operated arm (OA) or receiving breast-conserving surgery. However, it was not possible to predict recovery over the 2 years postoperatively on the basis of an individual woman's recovery at 1 month postoperatively. The eventual recovery of abduction or flexion range of movement was not related to the dominance of the OA nor to the surgical procedure performed. The PMCP provided in the early postoperative period is effective in facilitating and maintaining the recovery of shoulder movement over the first 2 years after breast cancer surgery.
Collapse
Affiliation(s)
- Robyn C Box
- Department of Physiotherapy, University of Queensland, Brisbane, Australia.
| | | | | | | |
Collapse
|
50
|
Aitken ME, Mustoe TA. Why change a good thing? Revisiting the fleur-de-lis reconstruction of the breast. Plast Reconstr Surg 2002; 109:525-33; discussion 534-8. [PMID: 11818831 DOI: 10.1097/00006534-200202000-00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the latissimus flap is known for its simplicity and reliability, use of the fleur-de-lis pattern was plagued by undesirable T-shaped donor sites and small breast volumes in thin patients. We report a modified technique for optimal shaping of the standard latissimus with the successful application of a modified fleur-de-lis pattern. Because a "wet" tumescent infiltration was utilized and large amounts of subcutaneous fat were harvested, these changes permitted application to a wide variety of patients, with generous breast volumes reducing the size of the implant placed and resulting in excellent donor-site scars. This is a retrospective cohort study of 53 delayed or immediate reconstructions performed consecutively by the principal author (M.E.A.) on 48 patients at a university-based, urban hospital. Each case was analyzed between April of 1995 and February of 1999, with a follow-up from 2.5 to 44 months. All patients underwent injection of tumescent solution into the subcutaneous plane and harvest of large amounts of subcutaneous fat with the neurologically intact latissimus muscle. The last 25 reconstructions utilized the modified fleur-de-lis skin pattern, an inferiorly based vertical limb and replacement of skin deficiency in both axes. Of 11 perioperatively irradiated patients, none required skin grafting, whereas 6 percent of all native mastectomy flaps were grafted. There was one instance of minor distal tip flap necrosis in a nonirradiated patient. No implants became infected or were extruded. Donor sites were without wound complications and unveiled a 16 percent overall seroma rate.Through selective addition of harvested tissue, this modified technique, particularly the fleur-de-lis pattern, permits improved volume and projection in the inferior pole. The T-shaped donor-site closure is not only acceptable, but is also desirable, with reduced wound tension and minimization of dog-ear formation. With a relative paucity of complications, this conceptually ideal modification is technically simple and aesthetically comparable to our transverse rectus abdominis muscle flap results.
Collapse
Affiliation(s)
- Marguerite E Aitken
- Department of Plastic and Reconstructive Surgery, Northwestern University Medical School, Chicago, IL 60611, USA
| | | |
Collapse
|