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Spiekerman van Weezelenburg MA, Bakens MJAM, Daemen JHT, Aldenhoven L, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons. Ann Surg Oncol 2024; 31:1643-1652. [PMID: 38038792 DOI: 10.1245/s10434-023-14631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND. METHODS A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding seroma formation, clinically significant seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method. RESULTS A total of 19 articles with 1962 patients were included. Ten different techniques to prevent seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen. CONCLUSIONS To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based guideline is needed.
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Affiliation(s)
| | - Maikel J A M Bakens
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - James van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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von Ahnen T, von Ahnen M, Militz-Müller S, Süß A, Schardey J, Schopf S, Schardey HM, Wirth U. Efficacy of four different hemostatic agents in thyroid surgery in reducing the amount of post-operative fluid collection. BMC Surg 2023; 23:303. [PMID: 37794384 PMCID: PMC10552291 DOI: 10.1186/s12893-023-02172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSES Postoperative bleeding remains a life-threatening complication in thyroid surgery. The aim was to assess the efficacy of four different hemostatic agents, Collagen-Fibrinogen-Thrombin Patch (CFTP) in two sizes (3 × 2.5 cm and 9.5 × 4.8 cm), polysaccharide particles (1 g) and Cellulose Gauze (2.5 × 5 cm) on postoperative drainage volume (DV) compared to a control group. METHODS We included from October 2007 until Mai 2011, 150 patients (30 per group) for this monocentric, retrospective case-controlled study. Patients were scheduled for a hemithyroidectomy or thyroidectomy. The primary endpoint was the postoperative DV within the first 24 h, secondary the incidence of adverse events. RESULTS There were no difference in demographic parameters. The mean DV (± SD) was 51.15 (± 36.86) ml in the control, 50.65 (± 42.79) ml in small (3 × 2.5 cm), 25.38 (± 23.99) ml in large CFTP (9.5 × 4.8 cm), 53.11 (± 39.48) ml in the polysaccharide particles and 48.94 (± 30.59) ml in the cellulose gauze group. DV was significantly reduced with the large CFTP (p < 0.05) compared to all other groups. There were no adverse events. CONCLUSIONS We were able to demonstrate a significant reduction in the DV for the large CFTP group compared to the other collectives. Although this as being associated with not inconsiderable costs and we would only recommend its use for high-risk patients only.
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Affiliation(s)
| | | | | | - Anna Süß
- Krankenhaus Agatharied GmbH, Hausham, Germany
| | | | | | | | - Ulrich Wirth
- Ludwig-Maximilians-Universität München, München, Germany
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Buch-Villa E, Castañer-Puga C, Delgado-Garcia S, Fuster-Diana C, Vidal-Herrador B, Ripoll-Orts F, Galeote-Quecedo T, Prat A, Andrés-Matias M, Jimeno-Fraile J, Muñoz-Sorsona E, Vento G, Gumbau-Puchol V, Adrianzen M, López-Flor V, Ortega J. Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial. Br J Surg 2023; 110:1180-1188. [PMID: 37311694 PMCID: PMC10416686 DOI: 10.1093/bjs/znad150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical outcomes between breast cancer patients who underwent axillary lymph node dissection with postoperative management using a polyethylene glycol-coated patch versus axillary drainage. The direct costs associated with both postoperative management strategies were also evaluated. METHODS This was a multicentre RCT in women with breast cancer who underwent axillary lymph node dissection (ClinicalTrials.gov identifier: NCT04487561). Patients were randomly assigned (1 : 1) to receive either drainage or a polyethylene glycol-coated patch as postoperative management. The primary endpoints were the need for an emergency department visit for any event related to the surgery and the rate of seroma development. RESULTS A total of 227 patients were included , 115 in the patch group (50.7 per cent) and 112 (29.4 per cent ) in the drainage group. The incidence of emergency department visits was significantly greater for patients with drainage versus a polyethylene glycol-coated patch (incidence rate difference 26.1 per cent, 95 per cent c.i. 14.5 to 37.7 per cent; P < 0.001). Conversely, the seroma rate was significantly higher in the polyethylene glycol-coated patch group (incidence rate difference 22.8 per cent, 95 per cent c.i. 6.7 to 38.9 per cent; P < 0.0055). Compared with drainage, using a polyethylene glycol-coated patch resulted in cost savings of €100.41 per patient. An incremental cost-effectiveness ratio analysis found that drainage was associated with an incremental cost-effectiveness ratio of €7594.4 for no need for hospital admission and €491.7 for no need for an emergency department visit. CONCLUSION Compared with patients who received drainage after axillary lymph node dissection, the use of a polyethylene glycol-coated patch resulted in a higher rate of seroma, but a lower number of postoperative outpatient or emergency department visits and thus a reduction in overall costs.
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Affiliation(s)
- Elvira Buch-Villa
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | | | | | - Carlos Fuster-Diana
- Department of Surgery, Valencian Institute of Oncology (IVO), Valencia, Spain
| | - Beatriz Vidal-Herrador
- Department of Surgery, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
| | | | | | - Antonio Prat
- Department of Surgery, General Hospital of Requena, Valencia, Spain
| | | | - Jaime Jimeno-Fraile
- Department of Surgery, University Clinical Hospital of Marques de Valdecilla, Santander, Spain
| | - Ernesto Muñoz-Sorsona
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Giovani Vento
- Department of Surgery, Valencian Institute of Oncology (IVO), Valencia, Spain
| | | | - Marcos Adrianzen
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Vicente López-Flor
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, University Clinical Hospital of Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
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Gasparri ML, Kuehn T, Ruscito I, Zuber V, Di Micco R, Galiano I, Navarro Quinones SC, Santurro L, Di Vittorio F, Meani F, Bassi V, Ditsch N, Mueller MD, Bellati F, Caserta D, Papadia A, Gentilini OD. Fibrin Sealants and Axillary Lymphatic Morbidity: A Systematic Review and Meta-Analysis of 23 Clinical Randomized Trials. Cancers (Basel) 2021; 13:cancers13092056. [PMID: 33923153 PMCID: PMC8123055 DOI: 10.3390/cancers13092056] [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: 01/10/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Axillary dissection is a highly mobile procedure with severe lymphatic consequences. The off-label application of fibrin sealants in the axilla, with the sole aim to eliminate dead space and to provoke sealing of the disrupted lymphatic vessels at the end of axillary dissection, is an experimental procedure to reduce lymphatic morbidity. The aim of our systematic review and meta-analysis is to investigate the effects of fibrin sealants on lymphatic morbidity after axillary dissection. Our results show that this experimental procedure is able to decrease the total axillary drainage output, the number of days before the axillary drainage is removed, and the length of hospital stay. However, no effects on the occurrence rate of axillary lymphocele or on the surgical site complications rate were demonstrated Abstract Background: use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy. Methods: randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes. Results: twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin’s disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied (p < 0.0001, p < 0.005, p = 0.008). Conclusion: fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found.
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Affiliation(s)
- Maria Luisa Gasparri
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), via Giuseppe Buffi 13, 6900 Lugano, Switzerland
| | - Thorsten Kuehn
- Interdisciplinary Breast Center, Department of Gynecology and Obstetrics, Klinikum Esslingen, 73730 Neckar, Germany;
| | - Ilary Ruscito
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Veronica Zuber
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Rosa Di Micco
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Ilaria Galiano
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | | | - Letizia Santurro
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Francesca Di Vittorio
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
| | - Francesco Meani
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
| | - Valerio Bassi
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany;
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland;
| | - Filippo Bellati
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, via di Grottarossa 1035, 00189 Rome, Italy; (I.R.); (F.B.); (D.C.)
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ospedale Regionale di Lugano EOC, via Tesserete 46, 6900 Lugano, Switzerland; (M.L.G.); (F.M.); (V.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), via Giuseppe Buffi 13, 6900 Lugano, Switzerland
- Correspondence:
| | - Oreste D. Gentilini
- Breast Surgery Unit, Department of Surgery, San Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy; (V.Z.); (R.D.M.); (I.G.); (L.S.); (F.D.V.); (O.D.G.)
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Al-Masri M, Alawneh F, Daoud F, Ebous A, Hamdan B, Al-Najjar H, Al-Masri R, Abu Farah M. Effectiveness of Cyanoacrylate in Reducing Seroma Formation in Breast Cancer Patients Post-Axillary Dissection: A Randomized Controlled Trial. Front Oncol 2021; 10:580861. [PMID: 33569343 PMCID: PMC7868378 DOI: 10.3389/fonc.2020.580861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background/Purpose Seroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a randomized clinical trial. Methods This is a single-center, randomized, single-blinded, and two-arm parallel study. Women with node-positive breast cancer eligible for axillary dissection were enrolled. Patients with a Body Mass Index (BMI) greater than 35 kg/m2, those who underwent immediate breast reconstruction, and/or received neoadjuvant chemotherapy were excluded. Patients were randomized in a 1:1 ratio, and were stratified according to their age, BMI, tumor size, and operation type. The primary endpoint was the total seroma volume (the total drained volume and the total aspirated volume after drain removal). Data presented as mean and range when applicable. Results 111 patients were randomized (Cyanoacrylate 57; control 54). 105 patients were analyzed. Sixty-nine patients underwent breast conserving surgery, and 36 underwent modified radical mastectomy. There was no difference in the total seroma volume between the Cyanoacrylate vs. control arms (1,304 (60–4,950) vs. 1,446 (100–5,223) ml, p=0.458). Wound infection, flap necrosis, number of manual aspirates, and hematoma formation were not statistically different between the two groups. Time to drain removal was shorter in the Cyanoacrylate arm (11.04(3–23) vs. 13.84(3–37) days, p=0.015). The use of Cyanoacrylate was not cost effective ($586.93 (550–748) vs. $29.63 (0–198), p<0.001). Higher seroma volume was correlated with modified radical mastectomy, older age, and BMI more than 30 kg/m2. Conclusion Cyanoacrylate did not reduce seroma formation and its use was not cost effective. Clinical Trial Registration clinicaltrials.gov, identifier NCT02141373.
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Affiliation(s)
- Mahmoud Al-Masri
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Fade Alawneh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Faiez Daoud
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ali Ebous
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Basem Hamdan
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Hani Al-Najjar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Rama Al-Masri
- School of Medicine, University of Jordan, Amman, Jordan
| | - Marwan Abu Farah
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
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Covarelli P, Barberini F, Cannavicci D, Cirocchi R, Rulli A, Boselli C, De Giorgi V. Reduction of postoperative lymphorrhoea in patients undergoing radical lymphadenectomy for stage III melanoma: prospective study using collagen-fibrin patches. MINERVA CHIR 2019; 75:111-116. [PMID: 31820617 DOI: 10.23736/s0026-4733.19.08114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical lymph nodes dissection (RLND) is the standard procedure for regional control of disease in patients with metastatic melanoma (stage III). Because of its aggressiveness, lymphorrhoea is a constant problem in postoperative. METHODS In this prospective nonrandomized study with a retrospective analysis of data, patients undergoing surgical treatment of axillary or iliac-inguinal RLND received standard treatment plus a collagen-fibrin sealant patch (TachoSil) (N.=50) or standard treatment alone (N.=50). The first endpoint was the comparison between the treated population and the control group, in terms of persistence of drainage and average daily volume of lymphorrhoea. The second aim was to relate patients' BMI, volume of lymphorrhoea and time of drainage in the two groups. RESULTS In the comparison between the two groups receiving or not the treatment with collagen-fibrin patch, we found an average difference both in the volume of daily lymphorrhoea (42.91±6.61 cc) and in the persistence of drainage (9.292±1.644 days) with P value <0.0001. Besides, the collagen-fibrin patch was actually effective in reducing lymphorrhoea and time of drainage, regardless of patients' BMI. CONCLUSIONS The results of this study confirm and support the starting thesis: TachoSil is an effective tissue sealant able to reduce lymphorrhoea and drainage removal times following a radical lymphadenectomy, independently from the BMI.
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Affiliation(s)
- Piero Covarelli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy -
| | - Francesco Barberini
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Cannavicci
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Rulli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Intraoperative hypertonic saline irrigation preventing seroma formation and reducing drain secretion in extended endoscopic hernia and linea alba reconstruction glue. Hernia 2019; 23:1291-1296. [PMID: 31055707 DOI: 10.1007/s10029-019-01956-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Subcutaneous Seroma formation (SF) is commonly seen after abdominal wall Hernia surgeries and reconstructive surgeries due to large dissecting dead space and is associated with increased morbidity. SF is common particularly after big abdominal wall hernia repairs and its treatment can be challenging and long. Current prevention methods are not consistent and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of Intraoperative Hypertonic Saline Irrigation (IHSI) to abdominal wall subcutaneous large dead space, which prevent postoperative SF and enables early drain removal due to reduced secretions. METHODS Eight patients undergone the Extended Endoscopic Hernia & Linea Alba Reconstruction Glue surgery (eEHLARglue), for Ventral Hernias (VH) and Rectus Muscles Separation (RMS). An extensive Endoscopic 450cm2 dissection free surface of the anterior Rectus fascia, is performed prior to Hernia dissection and closing of the RMS. It is followed by onlay mesh placing over the repaired Rectus muscles and the mesh is fused into the muscles by Fibrin Glue. The novel preventive method is based on Intraoperative Irrigation of the vast cavity through the two 10 mm JP closed system drains with 20 cc of NaCl 12% left at site for 10 min. RESULTS Our early results with all our patients show seroma prevention, lower secretion rate of 20 cc in 10 h and drain removal within 20-24 h. CONCLUSIONS IHSI enhance adhesion formation and reduce secretion rate in wide subcutaneous dissection space like in eEHLARglue, therefore enables early drain removal and prevent SF. As a result, reducing overall morbidity and hospitalization period, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This simple technique could be used in other potential postoperative SF surgeries. Further larger study with a longer follow up is advised.
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8
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Weber WP, Tausch C, Hayoz S, Fehr MK, Ribi K, Hawle H, Lupatsch JE, Matter-Walstra K, Chiesa F, Dedes KJ, Berclaz G, Lelièvre L, Hess T, Güth U, Pioch V, Sarlos D, Leo C, Canonica C, Gabriel N, Zeindler J, Cassoly E, Andrieu C, Soysal SD, Ruhstaller T, Fehr PM, Knauer M. Impact of a Surgical Sealing Patch on Lymphatic Drainage After Axillary Dissection for Breast Cancer: The SAKK 23/13 Multicenter Randomized Phase III Trial. Ann Surg Oncol 2018; 25:2632-2640. [PMID: 29948418 DOI: 10.1245/s10434-018-6556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies and a meta-analysis showed that fibrin sealant patches reduced lymphatic drainage after various lymphadenectomy procedures. Our goal was to investigate the impact of these patches on drainage after axillary dissection for breast cancer. METHODS In a phase III superiority trial, we randomized patients undergoing breast-conserving surgery at 14 Swiss sites to receive versus not receive three large TachoSil® patches in the dissected axilla. Axillary drains were inserted in all patients. Patients and investigators assessing outcomes were blinded to group assignment. The primary endpoint was total volume of drainage. RESULTS Between March 2015 and December 2016, 142 patients were randomized (72 with TachoSil® and 70 without). Mean total volume of drainage in the control group was 703 ml [95% confidence interval (CI) 512-895 ml]. Application of TachoSil® did not significantly reduce the total volume of axillary drainage [mean difference (MD) -110 ml, 95% CI -316 to 94, p = 0.30]. A total of eight secondary endpoints related to drainage, morbidity, and quality of life were not improved by use of TachoSil®. The mean total cost per patient did not differ significantly between the groups [34,253 Swiss Francs (95% CI 32,625-35,880) with TachoSil® and 33,365 Swiss Francs (95% CI 31,771-34,961) without, p = 0.584]. In the TachoSil® group, length of stay was longer (MD 1 day, 95% CI 0.3-1.7, p = 0.009), and improvement of pain was faster, although the latter difference was not significant [2 days (95% CI 1-4) vs. 5.5 days (95% CI 2-11); p = 0.2]. CONCLUSIONS TachoSil® reduced drainage after axillary dissection for breast cancer neither significantly nor relevantly.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland.
| | | | | | | | - Karin Ribi
- SAKK Coordinating Center, Bern, Switzerland.,IBCSG Coordinating Center, Bern, Switzerland
| | | | - Judith Eva Lupatsch
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | | | - Federica Chiesa
- Breast Center Zürich, Zurich, Switzerland.,Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Konstantin Johannes Dedes
- Breast Cancer Center, Comprehensive Cancer Center Zurich, University Hospital of Zurich, Zurich, Switzerland
| | | | - Loic Lelièvre
- Centre du sein, Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland
| | - Thomas Hess
- Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Uwe Güth
- Breast Center Zürich, Zurich, Switzerland.,Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | | | | | | | | | - Jasmin Zeindler
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Savas Deniz Soysal
- Breast Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Ruhstaller
- Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Peter Martin Fehr
- Breast Center Graubünden, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Michael Knauer
- Breast Center St. Gallen, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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9
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Scientific surgery. Br J Surg 2016. [DOI: 10.1002/bjs.10462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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