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Al-Ostoot FH, Salah S, Khanum SA. An Overview of Cancer Biology, Pathophysiological Development and It's Treatment Modalities: Current Challenges of Cancer anti-Angiogenic Therapy. Cancer Invest 2024:1-46. [PMID: 38874308 DOI: 10.1080/07357907.2024.2361295] [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: 02/17/2021] [Accepted: 05/25/2024] [Indexed: 06/15/2024]
Abstract
A number of conditions and factors can cause the transformation of normal cells in the body into malignant tissue by changing the normal functions of a wide range of regulatory, apoptotic, and signal transduction pathways. Despite the current deficiency in fully understanding the mechanism of cancer action accurately and clearly, numerous genes and proteins that are causally involved in the initiation, progression, and metastasis of cancer have been identified. But due to the lack of space and the abundance of details on this complex topic, we have emphasized here more recent advances in our understanding of the principles implied tumor cell transformation, development, invasion, angiogenesis, and metastasis. Inhibition of angiogenesis is a significant strategy for the treatment of various solid tumors, that essentially depend on cutting or at least limiting the supply of blood to micro-regions of tumors, leading to pan-hypoxia and pan-necrosis inside solid tumor tissues. Researchers have continued to enhance the efficiency of anti-angiogenic drugs over the past two decades, to identify their potential in the drug interaction, and to discover reasonable interpretations for possible resistance to treatment. In this review, we have discussed an overview of cancer history and recent methods use in cancer therapy, focusing on anti-angiogenic inhibitors targeting angiogenesis formation. Further, this review has explained the molecular mechanism of action of these anti-angiogenic inhibitors in various tumor types and their limitations use. In addition, we described the synergistic mechanisms of immunotherapy and anti-angiogenic therapy and summarizes current clinical trials of these combinations. Many phase III trials found that combining immunotherapy and anti-angiogenic therapy improved survival. Therefore, targeting the source supply of cancer cells to grow and spread with new anti-angiogenic agents in combination with different conventional therapy is a novel method to reduce cancer progression. The aim of this paper is to overview the varying concepts of cancer focusing on mechanisms involved in tumor angiogenesis and provide an overview of the recent trends in anti-angiogenic strategies for cancer therapy.
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Affiliation(s)
- Fares Hezam Al-Ostoot
- Department of Chemistry, Yuvaraja's College, University of Mysore, Mysuru, India
- Department of Biochemistry, Faculty of Education & Science, Albaydha University, Al-Baydha, Yemen
| | - Salma Salah
- Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Shaukath Ara Khanum
- Department of Chemistry, Yuvaraja's College, University of Mysore, Mysuru, India
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Ikeda N, Akahori T, Yokotani T, Fujii T, Sho M. Total Sealing Technique (TST) with a bipolar vessel sealing system reduces lymphorrhea and seroma formation for axillary lymph node dissection in primary breast cancer. Surg Open Sci 2024; 19:1-7. [PMID: 38590584 PMCID: PMC11000114 DOI: 10.1016/j.sopen.2024.01.011] [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: 07/28/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background The purpose of this study is to evaluate the potential of a novel surgical procedure, the Total Sealing Technique (TST), using the latest bipolar vessel sealing system (BVSS; LigaSure™ Exact Dissector) to reduce lymphatic leakage and seroma formation after electrocautery axillary lymph node dissection (ALND) in breast cancer surgery. Prolonged drainage is a common occurrence after ALND, primarily due to lymphatic leakage. In addition, the presence of seroma often leads to delays in the administration of postoperative adjuvant chemotherapy even after drain removal. Methods We conducted a comparative analysis of 36 patients who underwent total mastectomy with ALND using conventional electrocautery technique (CONV) during the first 3 years, and 35 patients who underwent the same procedure using TST during the subsequent 3 years. The following factors were compared to assess the impact of TST: operation time, blood loss, total drainage volume, mean time to drain removal, postoperative hospital stay, mean time to initiation of postoperative chemotherapy, and postoperative complications in each group. Results TST significantly reduced drainage volume (360.5 vs. 820.6 mL, p < 0.001), days to drain removal (4.8 vs. 6.8 days, p < 0.001), postoperative hospital stay (5.9 vs. 9.6 days, p < 0.001), the incidence of seroma (28.6 % vs. 65.9 %, p = 0.001), and time to chemotherapy initiation (33.1 vs. 61.4 days, p < 0.001) compared to CONV. Conclusions TST in total mastectomy with ALND effectively decreases the incidence of lymphorrhea and seroma formation; thus, it can be recommended for total mastectomy with ALND.
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Affiliation(s)
- Naoya Ikeda
- Department of Surgery, Nara Medical University, Nara, Japan
| | | | | | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
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Roy S, Gupta SS, Singh U, Anand R, Bhat G, Sooraj R, Raam M, Aswinee R, Ramakant P, Singh KR, Misra AK. Prospective Study to Evaluate Efficacy of Single Versus Double Drains in Breast Cancer Patients Undergoing Surgery. Indian J Surg Oncol 2024; 15:437-445. [PMID: 38741623 PMCID: PMC11088602 DOI: 10.1007/s13193-024-01923-z] [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: 11/28/2023] [Accepted: 03/08/2024] [Indexed: 05/16/2024] Open
Abstract
Seroma formation is a common sequel following modified radical mastectomy (MRM), which hinders healing, may prolong hospital stay, and cause a delay in adjuvant treatment. Closed suction drains have been used to prevent formation of seroma; however, the use of a single drain in the axilla along with draining the mastectomy flaps and axilla separately remains a topic of debate. This prospective randomized dual-arm study was conducted in the Department of Endocrine Surgery. All female patients with carcinoma breast diagnosed on core tissue biopsy, undergoing modified radical mastectomy, upfront or post neoadjuvant systemic therapy were included. Patients were randomized into two groups. In the first group, a single drain was placed in the axilla whereas in the second group, a drain each was placed below the mastectomy flaps and the axilla. Patients' particulars and the weight of the mass excised along with the operative details were documented. The volume of the drain was recorded daily. The flap drain was removed on postoperative day 5 and the axillary drain was removed when the drain volume was less than 30 mL/24 h for 2 consecutive days. The period of drain placement, volume of drainage, volume of seroma (if formed), and other complications (if any) were recorded. Patients in the single drain group had a significantly earlier drain removal time as compared to those with double drains (p = 0.01). The number of patients in whom seroma formation had occurred was more in the double drain group, but the difference was not significant. The average volume of aspirated seroma fluid was insignificantly more in the single drain group. The only other complication noticed was flap necrosis-in 5% patients of the double drain group. Total volume of drainage (p < 0.0001) and type of drain (p = 0.0208) were associated with higher rates of seroma formation, whereas BMI (p = 0.0516), weight of excised breast mass (p = 0.407), and age (p = 0.6379) were not associated with the rate of seroma formation. Outcomes in terms of drain volume or seroma formation were statistically indifferent between the two groups. Still, use of only a single axillary drain should be promoted, keeping in mind the earlier drain removal period, better patient compliance, and reduced hospital stay.
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Affiliation(s)
- Shubhajeet Roy
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Shikhar S. Gupta
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Utkarsh Singh
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Rohit Anand
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, Uttar Pradesh India
| | - Ganesh Bhat
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Rizhin Sooraj
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Mithun Raam
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Rahalkar Aswinee
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Pooja Ramakant
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Kul Ranjan Singh
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
| | - Anand Kumar Misra
- Department of Endocrine Surgery, Shatabdi Phase II Hospital, King George’s Medical University, Shah Mina Shah Road, Chowk, Lucknow, 226003 Uttar Pradesh India
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Spiekerman van Weezelenburg MA, de Rooij L, Aldenhoven L, van Kuijk SMJ, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Drain-free mastectomy and flap fixation: The interim analysis of a randomized controlled noninferiority trial. J Surg Oncol 2024; 129:975-980. [PMID: 38173366 DOI: 10.1002/jso.27577] [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: 10/15/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Flap fixation after mastectomy has proven to be one of the most promising solutions to reduce seroma formation. Drain placement remains standard practice in many clinics, even though this may be redundant after flap fixation. METHODS This is a prospective randomized controlled trial comparing mastectomy and wound closure using flap fixation with or without drain placement. The primary outcome measure was clinically significant seroma (CSS) incidence. The aim of this interim analysis was to assess the assumptions for the sample size calculation and to provide preliminary results. RESULTS Between July 2020 and January 2023, 112 patients were included. CSS incidence was 9.1% in the drain group and 21% in the no-drain group. In total, 10 patients were lost to follow-up. These numbers are similar to the ones used for the sample size calculation. In the drain group, three patients required interventions for wound complications compared to nine in the no-drain group (odds ratio: 3.612 [95% confidence interval: 0.898-14.537]). CONCLUSION The sample size calculation seems to be correct and no protocol amendments are necessary. Current preliminary results show no significant differences in CSS incidence. Complete results should be awaited to draw a well-powered conclusion regarding drain policy after mastectomy.
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Affiliation(s)
| | - Lisa de Rooij
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Loeki Aldenhoven
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Sittard, Limburg, 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, Limburg, the Netherlands
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Cartaxo SB, Rosseto LA, Garcia EB, de Melo RCB, Neto LPM, de Castro Junior PG, Basso R, Ferreira LM, Nahas FX. Effectiveness of 5-Fluorouracil and Hypertonic Glucose in the Prevention of Post-mastectomy Seroma in an Experimental Animal Model. Aesthetic Plast Surg 2024; 48:510-518. [PMID: 37620566 DOI: 10.1007/s00266-023-03549-y] [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: 05/15/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Seroma is a frequent complication that can affect the final result of reconstructive and cosmetic surgeries. METHODOLOGY This study evaluated the effectiveness of 5-Fluorouracil and 75% hypertonic glucose in preventing seroma in a mastectomy rat model, as well as cellular and vascular events in adjacent tissues. A left mastectomy with lymphadenectomy was performed in 60 Wistar-Albino female rats. Animals randomly allocated to the control group (Group I; n = 20) were sutured right after mastectomy. The intervention groups received 1.0 mL of 75% hypertonic glucose (Group II; n = 20) or 1.0 mL of 5-Fluorouracil (Group III; n = 20) at the surgical site before suturing. The assessment of the presence of seroma was performed in all animals at 24, 48, and 72 h and on the 7th and 12th postoperative day. After the 12th day, a tissue sample was taken from the surgical site and sent for histological analysis. The occurrence of seroma was assessed using GEE. A significance level of 5% was adopted. RESULTS Differences in seroma formation over time were observed for both Control Group I (p=0.041) and Intervention Group II (p<0.001). In Intervention Group III, there was no difference in the percentage and volume of seroma across the assessment points (p=0.627). When both the Control and Intervention Group II were compared to Intervention Group III, we found a reduction in seroma formation in the last group. The reduction in the inflammatory process was more regular to Intervention Group III. CONCLUSION In this animal model, 5-Fluorouracil was more effective in preventing seroma formation than 75% Hypertonic Glucose. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sidney Bandeira Cartaxo
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil.
| | - Luiz Antonio Rosseto
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil
| | - Elvio Bueno Garcia
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil
| | - Rodrigo Cartaxo Bandeira de Melo
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil
| | | | | | | | - Lydia Masako Ferreira
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil
| | - Fabio Xerfan Nahas
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua Botucatu, 740-2° andar-Vila Clementino, CEP:04023-062, Sao Paulo, Sao Paulo, Brasil
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Cazzato V, Scarabosio A, Bottosso S, Rodda A, Vita L, Renzi N, Caputo G, Ramella V, Parodi PC, Papa G. Early Seroma Treatment Protocol Based on US-Guided Aspiration in DTI Prepectoral Reconstruction: A Prospective Study. Clin Breast Cancer 2023; 23:e542-e548. [PMID: 37806916 DOI: 10.1016/j.clbc.2023.09.003] [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: 08/08/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Seroma is a common complication after prepectoral prosthetic breast reconstruction with ADM, leading to wound dehiscencse, infection, and even loss of reconstruction at last. A new ultrasound (US) guided follow-up protocol has been applied to compare primary and secondary complications incidence and their treatment, and evaluate the effect of precocious seroma detection and its evacuation in reducing secondary complications. METHODS We enrolled 406 patients from January 1st, 2021 to July 1st, 2023 who underwent mastectomy and 1-stage prepectoral reconstruction with ADM. Experimental group counted 96 patients, whom have been treated as protocol fashion, therefore with multiple US-guided evaluations and eventual evacuations along with postoperative period; control group (310 patients) has exclusively been clinically evaluated. RESULTS Seroma incidence detected rate among experimental group, after 1-year follow-up, was 32.2%, compared to 16.8% in control cohort, additionally no other secondary complications were detected in the first group. Referring to the wound dehiscence incidence, a statistically significant higher frequency was observed in control group compared with treatment 1 (21.2% vs. 0%; P = .0027). CONCLUSIONS Seroma and correlated secondary complications may lead to additional surgeries, higher sanitary costs and even reconstructive failure. With a seriated US follow-up protocol application, the surgeon could promptly manage and treat seroma, decreasing additional complications rate, particularly wound dehiscence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vito Cazzato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Scarabosio
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Stefano Bottosso
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Agostino Rodda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Ludovica Vita
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nadia Renzi
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Glenda Caputo
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Ramella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy.
| | - Giovanni Papa
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
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Dehariya P, Agarwal N, Yadav SK, Agarwal P, Sharma D. Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial. World J Surg 2023; 47:2761-2766. [PMID: 37581639 DOI: 10.1007/s00268-023-07139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION We evaluated the impact of topical epinephrine with xylocaine on drainage after axillary lymph node dissection. METHODS Fifty-two women were randomized into two groups, epinephrine with xylocaine drainage (ED) and conventional drainage group (CD). The amount of drainage, duration of drainage catheter, incidence of seroma formation and wound infection were noted. RESULTS The mean total drainage volume was less in ED group as compared to CD group (195 ml vs. 353 ml; p = .002). Drainage catheter was removed earlier in ED group as compared to CD group (5.07 + / - 0.99 days vs. 6.65 + / - 1.07 days; p = 0.0001). The incidence of seroma and wound infection was similar in two groups. CONCLUSION Topical epinephrine with xylocaine after axillary lymph node dissection results in significantly decreased drainage volume and duration of drainage.
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Affiliation(s)
- Prerna Dehariya
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, 482003, India
| | - Namrata Agarwal
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, 482003, India
| | - Sanjay Kumar Yadav
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, 482003, India.
| | - Pawan Agarwal
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Medical College, Jabalpur, Madhya Pradesh, 482003, India
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Mohammed M, Hamza H, Omar MI, Hussein M, Tohamy M, Farouk B, Rezk K. Effect of Clavipectoral Fascia Suturing on Postmastectomy Seroma Formation. POLISH JOURNAL OF SURGERY 2023; 96:31-37. [PMID: 38629279 DOI: 10.5604/01.3001.0053.5996] [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] [Indexed: 04/19/2024]
Abstract
<b><br>Introduction:</b> Post-mastectomy seroma formation is a challenging sequela which has a negative impact on patient recovery and quality of life.</br> <b><br>Aim:</b> We aim to publicize our technique of clavipectoral fascia re-closure and to assess its efficacy in reducing the incidence of seroma formation.</br> <b><br>Methods:</b> This is a prospective randomized controlled trial, conducted in South Cancer institute, Assiut University, Egypt. It included 84 breast cancer patients who were randomly divided into two groups: a control group (n = 44) and a fascia suture group (n = 40). The patients were followed up until drain removal and then to 3 months after surgery.</br> <b><br>Results:</b> The fascia suture group showed significantly shorter duration of drain removal with a significant reduction in the total amount of drained fluid and the amount of drained fluid 1 week postoperatively. One patient in the fascia suture group developed Grade 2-3 seroma vs. 7 in the control group (P < 0.05).</br> <b><br>Conclusions:</b> Clavipectoral fascia suture technique is a simple and effective method for reducing seroma formation after mastectomy in breast cancer patients and is advisable in patients at a high risk for seroma formation.</br>.
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Affiliation(s)
- Mahmoud Mohammed
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt, Clinical fellow, Worcestershire Royal Hospital NHS Trust, UK
| | - Hesham Hamza
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Mohamed I Omar
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Mohammed Hussein
- Department of General Surgery, Faculty of Medicine, Assiut University, Egypt
| | - Moaaz Tohamy
- Department of Anesthesia, Intensive Care and Pain Management, South Egypt Cancer Institute, Assiut University, Egypt
| | - Basma Farouk
- Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Egypt
| | - Khalid Rezk
- Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Egypt
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Agrawal A, Romics L, Thekkinkattil D, Soliman M, Kaushik M, Barmpounakis P, Mortimer C, Courtney CA, Goyal A, Garreffa E, Carmichael A, Lane RA, Rutherford C, Kim B, Achuthan R, Pitsinis V, Goh S, Ray B, Grover K, Vidya R, Murphy J. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps. Breast 2023; 71:82-88. [PMID: 37544090 PMCID: PMC10430575 DOI: 10.1016/j.breast.2023.07.007] [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: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
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Affiliation(s)
- A Agrawal
- Cambridge University Hospitals, Cambridge, UK.
| | - L Romics
- New Victoria Hospital, Glasgow, UK.
| | | | - M Soliman
- Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt.
| | - M Kaushik
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - P Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece.
| | | | | | - A Goyal
- Royal Derby Hospital, Derby, UK.
| | | | - A Carmichael
- University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK.
| | - R A Lane
- Cambridge University Hospitals, Cambridge, UK.
| | | | - B Kim
- St. James's University Hospital, Leeds, UK.
| | - R Achuthan
- St. James's University Hospital, Leeds, UK.
| | | | - S Goh
- Peterborough Hospital, Peterborough, UK.
| | - B Ray
- Harrogate NHS Trust, Harrogate, UK.
| | | | - R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - J Murphy
- Manchester University Hospital, Manchester, UK.
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De Rooij L, Kimman ML, Spiekerman van Weezelenburg MA, van Kuijk SMJ, Granzier RWY, Hintzen KFH, Heymans C, Theunissen LLB, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Economic evaluation of flap fixation techniques after mastectomy: Results of a double-blind randomized controlled trial (SAM-trial). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107003. [PMID: 37542999 DOI: 10.1016/j.ejso.2023.107003] [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: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND An economic evaluation was performed alongside an RCT investigating flap fixation in reducing seroma formation after mastectomy. The evaluation focused on the first year following mastectomy and assessed cost-effectiveness from a health care and societal perspective. METHODS The economic evaluation was conducted between 2014 and 2018 in four Dutch breast clinics. Patients with an indication for mastectomy or modified radical mastectomy were randomly assigned to: conventional closure (CON), flap fixation with sutures (FFS) or flap fixation with tissue glue (FFG). Health care costs, patient and family costs and costs due to productivity losses were assessed. Outcomes were expressed in incremental cost-effectiveness ratios (ICERs): the incremental cost per quality-adjusted life year (QALY). Bootstrapping techniques, sensitivity and secondary analyses were employed to address uncertainty. RESULTS The FFS-group yielded most QALYs (0.810; 95%-CI 0.755-0.856), but also incurred the highest mean costs at twelve months (€10.416; 95%-CI 8.231-12.930). CON was the next best alternative with 0.794 QALYs (95%-CI 0.733-0.841) and mean annual costs of €10.051 (95%-CI 8.255-12.044). FFG incurred fewer QALYs and higher costs, when compared to the CON group. The ICER of FFS compared to CON was €22.813/QALY. Applying a willingness to pay threshold in the Netherlands of €20.000/QALY, the probability that FFS was cost-effective was 42%, compared to 37% and 21% for CON and FFG, respectively. CONCLUSION The cost-effectiveness of FFS following mastectomy, versus CON and FFG, is uncertain from a societal perspective. Yet, from a health care and hospital perspective FFS is likely to be the most cost-effective intervention.
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Affiliation(s)
- L De Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R W Y Granzier
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - K F H Hintzen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - C Heymans
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - L L B Theunissen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - E R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - A Janssen
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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11
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Köpke MB, Wild CM, Schneider M, Pochert N, Schneider F, Sagasser J, Kühn T, Untch M, Hinske C, Reiger M, Traidl-Hoffmann C, Dannecker C, Jeschke U, Ditsch N. Elderly and Patients with Large Breast Volume Have an Increased Risk of Seroma Formation after Mastectomy-Results of the SerMa Pilot Study. Cancers (Basel) 2023; 15:3606. [PMID: 37509269 PMCID: PMC10377181 DOI: 10.3390/cancers15143606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The collective of the SerMa pilot study included 100 cases of primary breast cancer or Carcinoma in situ who had undergone a mastectomy procedure with or without reconstruction of the breast using an implant or expander at Augsburg University Hospital between 12/2019 and 12/2022. The study aimed to investigate possible causes of seroma formation; reported here are the clinicopathological correlations between seroma formation and tumor biology and surgical procedures. Seroma occurred significantly more often in patients with older age (median patient age in cases with seroma was 73 years vs. 52 years without seroma; p < 0.001). In addition, patients with larger mastectomy specimen were significantly more likely to develop seroma (median ablation weight in cases with seroma 580 g vs. 330 g without seroma; p < 0.001). Other significant parameters for seroma formation were BMI (p = 0.005), grading (p = 0.015) and tumor size (p = 0.036). In addition, with insertion of implant or expander, a seroma occurred significantly less frequently (p < 0.001). In a binary logistic regression, age in particular was confirmed as a significant risk factor. In contrast, tumor biological characteristics, number of lymph nodes removed or affected showed no significant effect on seroma formation. The present study shows the need for patient education about the development of seroma in particular in older patients and patients with large breast volumes within the preoperative surgical clarification. These clinicopathological data support the previously published results hypothesizing that seroma formation is related to autoimmune/inflammatory processes and will be tested on a larger collective in the planned international multicenter SerMa study.
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Affiliation(s)
- Melitta Beatrice Köpke
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Carl Mathis Wild
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
- Institute for Digital Medicine, University Augsburg, 86153 Neusäß, Germany
| | - Mariella Schneider
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Nicole Pochert
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
- Department for Environmental Medicine, Medical Faculty, University Augsburg, 86156 Augsburg, Germany
| | - Felicitas Schneider
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Jacqueline Sagasser
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Thorsten Kühn
- Clinic for Gynaecology and Obstetrics, Filderklinik, Filderstadt-Bonlanden, 70794 Filderstadt, Germany
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89070 Ulm, Germany
| | - Michael Untch
- Helios Clinic Berlin-Buch, Obstetrics and Gynaecology, 13125 Berlin, Germany
| | - Christian Hinske
- Institute for Digital Medicine, University Augsburg, 86153 Neusäß, Germany
| | - Matthias Reiger
- Department for Environmental Medicine, Medical Faculty, University Augsburg, 86156 Augsburg, Germany
| | - Claudia Traidl-Hoffmann
- Department for Environmental Medicine, Medical Faculty, University Augsburg, 86156 Augsburg, Germany
| | - Christian Dannecker
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Udo Jeschke
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Nina Ditsch
- Department of Gynecology and Obstetrics, University Hospital Augsburg, 86156 Augsburg, Germany
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12
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Borg G, Dihge L, Johansson K. Risk factors for seroma formation after axillary lymph node dissection with special focus on the impact of early shoulder exercise. Acta Oncol 2023:1-7. [PMID: 37129993 DOI: 10.1080/0284186x.2023.2203831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Shoulder and arm dysfunction such as reduced range of motion (ROM) and seroma formation, are common complications following axillary lymph node dissection (ALND). There are conflicting results on the effect of early postoperative exercise on the risk of seroma. This study aims to present incidence of symptomatic seroma formation in a large, population-based cohort, and assesses whether early shoulder mobilization, and other common patient and treatment-related factors are predictors of seroma. METHODS This observational cohort study at the Surgical clinic at Lund University Hospital in Sweden, included 217 consecutive patients who underwent ALND due to breast cancer, cutaneous malignant melanoma (CMM), or carcinoma of unknown primary. A shoulder exercise program was introduced on the first postoperative day and data were collected at routine follow-up 4-6 weeks postsurgery. Main outcome was the strength of the associations between postsurgery exercise and seroma incidence based on logistic regression analyses, supported by data on seroma volume and number of aspirations. RESULTS Two hundred patients completed the study. The overall seroma incidence was 67.5% and the odds of seroma were lower for patients practicing ROM exercise two times/day versus 0-1 time/day (OR 0.42, 95% CI 0.18-0.96, p = .038). ROM exercise greater than two times/day did not increase the volume, neither did the arm cycling exercise. ALND combined with mastectomy and CMM surgery were associated with larger seroma volumes (1116 ± 1068ml, p = .006) and (1318 ± 920 ml, p < .001), respectively, compared to the breast conserving surgery (537 ± 478ml) while neoadjuvant chemotherapy showed no influence. The effect of age, patients ≥60 years compared to younger, or BMI ≥ 30.0 were weaker (p = .08). CONCLUSIONS Extensive surgical treatments for breast cancer and malignant melanoma produces more seroma, and higher age and obesity may also influence the risk. ROM exercises twice daily predict a lower incidence of seroma following ALND, and more frequent shoulder exercise do not increase the volumes.
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Affiliation(s)
- Gunilla Borg
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Looket Dihge
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Karin Johansson
- Department of Health Sciences, Lund University, Lund, Sweden
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13
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Faur FI, Clim IA, Dobrescu A, Isaic A, Prodan C, Florea S, Tarta C, Totolici B, Duţă C, Pasca P, Lazar G. The Use of Wound Infiltration for Postoperative Pain Management after Breast Cancer Surgery: A Randomized Clinical Study. Biomedicines 2023; 11:biomedicines11041195. [PMID: 37189812 DOI: 10.3390/biomedicines11041195] [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: 02/15/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The present study aims to evaluate the reduction of postoperative pain in breast surgery using a series of local analgesics, which were infiltrated into the wound; (2) Methods: Envelopes containing allocation were prepared prior to the study. The patients involved were randomly assigned to the groups of local anesthesia infiltration (Group A) or normal pain management with intravenous analgesics (Group B). The random allocation sequence was generated using computer-generated random numbers. The normally distributed continuous data were expressed as the means (SD) and were assessed using the analysis of variance (ANOVA), independent-sample t-test, or paired t-test; (3) Results: The development of the postoperative pain stages was recorded using the VAS score. Therefore, for Group A, the following results were obtained: the VAS at 6 h postoperatively showed an average value of 0.63 and a maximum value of 3. The results for Group B were the following: the VAS score at 6 h postoperatively showed an average value of 4.92, a maximum of 8, and a minimum of 2; (4) Conclusions: We can confirm that there are favorable statistical indicators regarding the postoperative pain management process during the first 24-38 h after a surgical intervention for breast cancer using local infiltration of anesthetics.
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Affiliation(s)
- Flaviu Ionut Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Ioana Adelina Clim
- IInd Obstetric and Gynecology Clinic "Dominic Stanca", 400124 Cluj-Napoca, Romania
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Catalin Prodan
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Sabrina Florea
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania
- Department of General Surgery, Faculty of Medicine, "Vasile Goldiș" Western University of Arad, 310025 Arad, Romania
| | - Ciprian Duţă
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
| | - Gabriel Lazar
- Department of Oncology Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Ist Clinic of Oncological Surgery, Oncological Institute "Prof Dr I Chiricuta" Cluj-Napoca, 400015 Cluj-Napoca, Romania
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14
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Smith CB, Baker JA, Yoon SC, Lowell DA, Grimm L. Ethanol Sclerotherapy for Postoperative Seroma of the Breast and Axilla. JOURNAL OF BREAST IMAGING 2023; 5:167-173. [PMID: 38416938 DOI: 10.1093/jbi/wbad001] [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: 07/21/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Evaluate the effectiveness of alcohol sclerotherapy in postoperative breast and axillary seromas. METHODS This was an IRB-approved retrospective review of consecutive patients from 2017 to 2021. The procedure involves aspiration of seroma fluid, injection of ethanol for 15 to 30 minutes, and then aspiration of the injected ethanol. Following review of the medical record, patient and procedure data were recorded. Success was defined as no recurrence of seroma. Statistical analysis was performed using a chi-square or t-test, as appropriate. RESULTS Twenty seromas were treated in 19 patients (mean age, 63 years; range, 49-79) following mastectomy (9/20, 45%), lumpectomy (25%, 5/20), axillary nodal dissection (5/20, 25%), or chest wall surgery (1/20, 5%). The mean seroma volume was 146 ± 165 mL. There was a mean of 1.4 prior aspiration attempts (range, 0-3). Mean injected ethanol volume was 39 mL (range, 8-60 mL) for a mean of 26 ± 5 minutes. Seromas recurred in 85% (17/20) of cases, and repeat aspiration was performed in 35% (6/17). The mean recurrence time was 34 ± 29 days. The recurrent seromas were 31% smaller (mean, 80 ± 48 mL). Only a smaller pre-ablation seroma was associated with successful ablation (P < 0.01), as the mean pre-ablation volume was 36 ± 24 mL for successful ablations and 119 ± 56 mL for unsuccessful ablations. There were no post-procedural complications. CONCLUSION Single-treatment ethanol sclerotherapy is typically unsuccessful in ablating breast and axillary seromas. Only a smaller pre-ablation seroma size was associated with successful ablation.
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Affiliation(s)
- Camron B Smith
- University of Kansas Medical Center, Department of Radiology, Kansas City, KS, USA
| | - Jay A Baker
- Duke University Hospital, Department of Radiology, Durham, NC, USA
| | - Sora C Yoon
- Duke University Hospital, Department of Radiology, Durham, NC, USA
| | - Dorothy A Lowell
- Duke University Hospital, Department of Radiology, Durham, NC, USA
| | - Lars Grimm
- Duke University Hospital, Department of Radiology, Durham, NC, USA
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15
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Roman MM, Delrue P, Karler C, Del Marmol V, Bourgeois P. Indo-cyanine green administration to identify loss of lymph after axillary lymph node dissection. Front Oncol 2023; 13:1045495. [PMID: 36994214 PMCID: PMC10040774 DOI: 10.3389/fonc.2023.1045495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/16/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundNear infrared fluorescence imaging with Indocyanine Green (ICG) is now used for the imaging of lymph nodes and lymphatic vessels. In this work, we investigated the impact of its pre-operative and peri-operative administration on our ability to detect axillary lymphatic loss after breast cancer surgery.MethodsOne subcutaneous injection of ICG was administered in the ipsilateral hand of 109 women who were scheduled to have either a mastectomy with total axillary lymph node dissection (CALND) or a lumpectomy with selective lymphadenectomy (SLN) the day before (n = 53) or the same day of surgery (n = 56). The lymph leakages were assessed by means of the application of a compress in the operated armpit and by the presence or absence of fluorescence on it, as well as in the post-operative axillary drains.ResultsThe compress was fluorescent in 28% of SLN patients and 71% of CALND patients. The liquids in the axillary drains were also fluorescent in 71% of patients with CALND. No statistical significance was observed between the ICG injection groups. The association between compressive fluorescent and the presence of fluorescence in the axillary drains is significant in the pre-operative subgroup and in the whole group.ConclusionOur research demonstrates that lymphatic leaks aid in the development of seromas and calls into question the effectiveness of the ligatures and/or cauterizations used during surgery. A prospective, multicentric, randomized trial should be conducted to verify the efficacy of this approach.
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Affiliation(s)
- Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Mirela Mariana Roman,
| | - Pauline Delrue
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Clarence Karler
- Department of Anesthesia-Algologia Hospital Moliere, Université Libre de Bruxells, Brussels, Belgium
| | - Véronique Del Marmol
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Bourgeois
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Services of Nuclear Medicine, Institut Jules Bordet and Hôpitaux Iris Sud- Iris Ziekenhuizen Zuid (HIS-IZZ) Hospitals, Université Libre de Bruxelles, Brussels, Belgium
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Service of Vascular Surgery, Institut Jules Bordet and Hôpitaux Iris Sud- Iris Ziekenhuizen Zuid (HIS-IZZ) Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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16
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Teotia SS, Kadakia Y, Amaya J, Liu Y, Haddock NT. Evaluating the Efficacy of Povidone-Iodine Solution Infection Prophylaxis in Immediate Tissue Expander-Based Breast Reconstruction: A Controlled Retrospective Analysis. Plast Surg (Oakv) 2023; 31:29-35. [PMID: 36755822 PMCID: PMC9900035 DOI: 10.1177/22925503211024762] [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: 12/16/2020] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is currently no consensus among plastic surgeons regarding the optimal infection prophylaxis for immediate tissue expander placement following mastectomy. The goal of this study was to determine whether irrigation with 1 L of standard triple antibiotic solution (TAS) can achieve similar infection rates compared to a regimen of 180 mL of TAS with povidone-iodine solution (Betadine) painted on the field immediately prior to the placement of the expander. Methods: The 2 regimens were compared via retrospective propensity matching of all patients of the 2 senior authors who underwent bilateral tissue expander placement immediately following mastectomy with one of 3 mastectomy surgeons from January 2013 to December 2019 (n = 281). Groups were controlled for mastectomy surgeon, mastectomy type, mastectomy weight, age, race, body mass index, diabetes, hypertension, smoking, smoking status, prepectoral/subpectoral placement, use of acellular dermal matrix, operating room time, and duration of postoperative antibiotics. Results: Compared to the Betadine cohort (n = 65), the non-Betadine cohort (n = 65) experienced a similar rate of infections (13.8% vs 12.3%, P = 1.00), including major injections requiring intravenous antibiotic treatment (10.8% vs 9.2%, P = 1.00), after propensity matching. Infections in the non-Betadine cohort did not grow different bacteria on culture, require different antibiotic coverage, or result in prolonged duration of average antibiotic therapy (12.0 days vs 19.3 days, P = .19). Rates of subsequent expander washout and exchange (P = 1.00) and overall complications that required return to the operating room (P = .826) were similar between groups. Conclusion: The addition of Betadine solution to TAS added no benefit to infection prophylaxis or reduction of surgical complications in immediate tissue expander placement procedures.
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Affiliation(s)
- Sumeet S. Teotia
- Department of Plastic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Yash Kadakia
- Department of Plastic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Joshua Amaya
- Department of Plastic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Yulun Liu
- Department of Plastic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, USA
| | - Nicholas T. Haddock
- Department of Plastic Surgery, University of Texas Southwestern
Medical Center, Dallas, TX, USA
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Papanikolaou A, Minger E, Pais MA, Constantinescu M, Olariu R, Grobbelaar A, Lese I. Management of Postoperative Seroma: Recommendations Based on a 12-Year Retrospective Study. J Clin Med 2022; 11:jcm11175062. [PMID: 36078992 PMCID: PMC9457167 DOI: 10.3390/jcm11175062] [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: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Seroma formation is a serious postoperative complication. Since the management algorithms available in the literature are scarce, we aimed to analyze our experience with postoperative seroma in order to identify indicators for revisional surgery and propose recommendations for management. Methods: This retrospective study included all patients with postoperative seroma treated in a tertiary university hospital from 2008 to 2020. Patients’ demographics, medical history, and seroma treatment details were recorded and analyzed. Results: Overall, 156 patients were included: 41% were initially treated through needle aspiration, with 61% eventually undergoing surgical treatment for postoperative seroma. Comorbidities, such as heart failure and coronary heart disease, were significantly associated with an increased need for revisional surgery (p < 0.05). Both a duration of >40 days of repeated needle aspirations and drain re-insertions were significantly correlated with an increased risk for revisional surgery (p < 0.05). Conclusion: Patients requiring seroma aspiration should be counseled on surgical treatment sooner rather than later, as prolonged aspiration time (over 40 days) greatly increases the risk of surgical revision. Moreover, the reinsertion of a drain should only be used as a temporizing measure, at most, and patients requiring a drain to control the size of the seroma should promptly be scheduled for a surgical revision.
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Affiliation(s)
- Athanasios Papanikolaou
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Eliane Minger
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Michael-Alexander Pais
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
- Correspondence:
| | - Mihai Constantinescu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
| | - Adriaan Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Ioana Lese
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
- Department for BioMedical Research, University of Bern, 3008 Bern, Switzerland
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18
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Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer. Cancers (Basel) 2022; 14:cancers14153835. [PMID: 35954498 PMCID: PMC9367341 DOI: 10.3390/cancers14153835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery. Abstract Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.
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Gibson AL, Watkins JE, Agrawal A, Tyminski MM, DeBenedectis CM. Shedding Light on T2 Bright Masses on Breast MRI: Benign and Malignant Causes. JOURNAL OF BREAST IMAGING 2022; 4:430-440. [PMID: 38416977 DOI: 10.1093/jbi/wbac030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 03/01/2024]
Abstract
While T2 hyperintense masses on breast MRI are often benign, there are several malignant etiologies that can also be T2 hyperintense. Delineation between benign and malignant entities is important for the accurate interpretation of breast MRI. Common benign T2 hyperintense masses include cysts, fibroadenomas, and lymph nodes. Malignant processes that are T2 hyperintense include metastatic lymph nodes, mucinous breast carcinomas, papillary breast carcinomas, and breast cancers with central necrosis. Evaluation of the morphology and enhancement pattern of a T2 hyperintense mass can help to differentiate a benign process from a malignant one. This educational review will present both benign and malignant causes of T2 hyperintense masses on breast MRI and review common imaging findings and pertinent imaging characteristics that can be used to help accurately identify benign entities while also recognizing suspicious lesions that require additional evaluation.
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Affiliation(s)
- Averi L Gibson
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Jade E Watkins
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Anushree Agrawal
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
| | - Monique M Tyminski
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA, USA
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Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplasty. Plast Reconstr Surg 2022; 149:1106e-1113e. [PMID: 35383695 DOI: 10.1097/prs.0000000000009114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The changes in the pattern of lymphatic drainage of the superficial abdominal wall after abdominoplasty are still unknown. These changes may increase the risk of numerous complications, including seroma formation. Depending on the alterations, the manual lymphatic drainage technique should be modified in postoperative patients. The aim of this study was to map the pattern of lymphatic drainage of the superficial infraumbilical abdominal wall after abdominoplasty. METHODS Twenty women with indications for abdominoplasty were selected in the Plastic Surgery Division of the Federal University of São Paulo. Intradermal lymphoscintigraphy with dextran 500-99m-technetium was performed in 20 female patients in the preoperative phase and 1 and 6 months after abdominoplasty to evaluate superficial lymphatic drainage of the abdominal wall. RESULTS Before surgery, all patients presented with abdominal lymphatic drainage toward the inguinal lymph nodes. One and 6 months after abdominoplasty, only 15 percent exhibited the same drainage pathway. Drainage toward the axillary lymph node chain occurred in 65 percent of the patients, 10 percent displayed a drainage pathway toward both the axillary and inguinal lymph nodes, and lymphatic drainage was indeterminate in 10 percent of the cases. CONCLUSIONS A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period. However, 35 percent of cases exhibited alternative drainage. No significant changes were documented between 1 and 6 months postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Kumar V N, Hulikal N, Banoth M. A Randomized Controlled Study of Quilting with Axillary Lymphatic Ligation Versus Conventional Modified Radical Mastectomy in Patients with Breast Cancer. Indian J Surg Oncol 2022; 13:245-250. [DOI: 10.1007/s13193-021-01453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022] Open
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The efficacy of oxidized regenerated cellulose (SurgiGuard®) in breast cancer patients who undergo total mastectomy with node surgery: A prospective randomized study in 94 patients. PLoS One 2022; 17:e0267694. [PMID: 35622779 PMCID: PMC9140258 DOI: 10.1371/journal.pone.0267694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Seromas frequently develop in patients who undergo total mastectomy with node surgery. We aimed to prospectively explore whether use of oxidized regenerated cellulose (ORC, SurgiGuard®) affects seroma formation after total mastectomy with node surgery (sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)). Materials and methods Ninety four breast cancer patients were enrolled in the study who underwent total mastectomy with ALND or SLNB. The patients were randomized into two groups, one treated with ORC plus closed suction drainage and the other with closed suction drainage alone. Results Mean drainage volume was slightly lower in the ORC group on postoperative day 1 (123 ± 54 vs 143 ± 104 ml), but was slightly higher at all other time points; however, these differences were not significant. Mean total drainage volume in patients treated with ORC plus drainage did not differ from that of patients treated with drainage alone (1134 ± 507 ml vs 1033 ± 643 ml, P = 0.486). Conclusions Use of ORC (SurgiGuard®) did not significantly alter the risk of seroma formation.
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A comparative study of Drain in Oncoplastic Breast Conserving Surgery (therapeutic mammaplasty and chest wall perforator flap partial breast reconstruction) versus mastectomy. Clin Breast Cancer 2022; 22:619-627. [DOI: 10.1016/j.clbc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/17/2023]
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Zhang M, Liu Y, Yang H, Jin F, Zheng A. Breast adenoid cystic carcinoma: a report of seven cases and literature review. BMC Surg 2022; 22:113. [PMID: 35331206 PMCID: PMC8953026 DOI: 10.1186/s12893-022-01560-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Primary adenoid cystic carcinoma (ACC) of breast is rarely seen clinically. It is a special subtype of triple-negative breast cancer characterized by low expression of Ki-67, low malignant potential, slow progression and favorable prognosis. To date, treatment for this disease is controversial and no consensus is reached. We analyzed clinical manifestations and pathological characteristics of seven primary breast ACC cases and reported in combination with literature review to promote understanding, diagnosis and treatment of this disease. Case presentation We collected seven breast ACC cases pathologically diagnosed and treated in Department of breast surgery of the First Affiliated Hospital of China Medical University from January 2015 to December 2018. We organized and summarized the clinical, imaging, pathological and prognostic information and performed statistical analysis. The median age was 60 years (ranging from 54 to 64 years). Tumors of all patients were detected by immunohistochemistry. Molecular types were mostly triple negative (4/7), and Ki-67 expression was low (5/7). Lymph node metastases were absent in all patients received axillary lymph node surgery. Median follow-up time was 39 months (ranging from 25 to 68 months). There was no occurrence of relapse, distant metastasis or death. Conclusion Breast ACC is accompanied with favorable diagnosis, which is different from typical triple-negative breast cancer. Accurate diagnosis of ACC is particularly important.
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Affiliation(s)
- Meilin Zhang
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Burn Plastic Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Yanbiao Liu
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongguang Yang
- Department of Burn Plastic Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Feng Jin
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Ang Zheng
- Department of Breast Surgery, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Rao D, Xie J, Xia Y, Cao D. Comparison of Flap Fixation to Its Bed and Conventional Wound Closure with Drainage in Preventing Seroma Formation Following Mastectomy for Breast Cancer: Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:1180-1188. [PMID: 35226117 DOI: 10.1007/s00266-022-02814-w] [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: 10/04/2021] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Seroma formation is a common complication following mastectomy. The objective of this systematic review and meta-analysis is to evaluate the impact of flap fixation techniques that omit drainage versus conventional closed drainage on seroma formation and related complications after mastectomy. METHODS Clinical studies of flap fixation techniques versus the conventional closure technique in patients undergoing mastectomy with or without axillary clearance were retrieved from the PubMed, Embase and Cochrane databases. Papers were eligible for inclusion if the outcome was described in terms of seroma formation. Studies older than 20 years, animal studies and studies involving patients undergoing direct breast reconstruction were excluded. RESULTS Four randomized controlled trials (RCTs) and four cohort studies were included in our examination. Compared with the conventional drainage group, the flap fixation group had a similar incidence of seroma formation (OR 0.76, 95% CI 0.30-1.93, p = 0.57). CONCLUSION Based on current evidence, mechanical flap fixation can replace conventional drainage without increasing seroma formation after mastectomy. Further well-designed RCTs are warranted to evaluate the effects of flap fixation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Tansawet A, Nakchuai P, Techapongsatorn S, Sukhvibul P, Lolak S. Prediction of seroma after total mastectomy using an artificial neural network algorithm. Breast Dis 2022; 41:21-26. [PMID: 34250921 DOI: 10.3233/bd-201051] [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] [Indexed: 06/13/2023]
Abstract
Seroma is a common complication after mastectomy. To the best of our knowledge, no prediction models have been developed for this. Henceforth, medical records of total mastectomy patients were retrospectively reviewed. Data consisting of 120 subjects were divided into a training-validation data set (96 subjects) and a testing data set (24 subjects). Data was learned by using a 9-layer artificial neural network (ANN), and the model was validated using 10-fold cross-validation. The model performance was assessed by a confusion matrix in the validating data set. The receiver operating characteristic curve was constructed, and the area under the curve (AUC) was also calculated. Pathology type, presence of hypertension, presence of diabetes, receiving of neoadjuvant chemotherapy, body mass index, and axillary lymph node (LN) management (i.e., sentinel LN biopsy and axillary LN dissection) were selected as predictive factors in a model developed from the neural network algorithm. The model yielded an AUC of 0.760, which corresponded with a level of acceptable discrimination. Sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 52.9%, 66.7%, 46.7%, and 100%, respectively. Our model, which was developed from the ANN algorithm can predict seroma after total mastectomy with high sensitivity. Nevertheless, external validation is still needed to confirm the performance of this model.
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Affiliation(s)
- Amarit Tansawet
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Panupong Nakchuai
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Suphakarn Techapongsatorn
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Pakkapol Sukhvibul
- Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sermkiat Lolak
- Section of Data Science for Healthcare, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Prajapati S, Ramasamy S, Vats M, Neogi S, Kantamaneni K, Tudu SK. Effect of Octreotide on Lymphorrhea in Patients After Modified Radical Mastectomy for Carcinoma Breast: A Randomized Controlled Trial. Cureus 2021; 13:e19225. [PMID: 34877203 PMCID: PMC8642125 DOI: 10.7759/cureus.19225] [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] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Lymphorrhea or seroma formation after modified radical mastectomy (MRM) is a serious and disabling complication of axillary lymphadenectomy. Octreotide is a hormone with general anti-secretory effects. The potential role of octreotide in the treatment of lymphorrhea after axillary lymph node dissection in patients undergoing MRM is being investigated in this study. The purpose of this research is to study the effect of octreotide on the magnitude and duration of lymphorrhea in patients after MRM for carcinoma breast. Methods This clinical trial was registered in the Clinical Trials Registry India (CTRI/2017/11/010653). It was conducted in the Department of General Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from September 2015 to March 2017. This study is a parallel randomized controlled trial with a 1:1 allocation ratio. Thirty patients were enrolled and allocated equally into two groups. The intervention group received standard medical care plus injection octreotide 100 micrograms eight hourly intravenously post-operatively for five days and the control group received only standard medical care. The primary outcomes were lymphorrhea volume from 24 hours post-surgery till five days post-operatively and the number of days till the suction drain was removed. Secondary outcomes were surgical site infection, the incidence of seroma formation, complications of octreotide, duration of hospital stay, and the number of lymph nodes isolated. All the patients were followed up twice a week for the first six weeks after discharge followed by three monthly visits. Results A total of 30 patients were included in the study. The mean age was 46.2 years. The mean operative time in the control group was 137.87 ± 23.28 minutes and in the octreotide group was 128.13 ± 12.29 (p = 0.163). The volume of lymphorrhea in the control group was 354.67 ± 346.28 ml and in the octreotide group was 194.00 ± 240.62 ml (p = 0.081). Seroma occurred in 9% of patients in the control group and 2 % of patients in the octreotide group (p = 0.010). The duration of lymphorrhea was 4.93 ± 2.49 days in the control group and 3.13 ± 1.36 days in the octreotide group (p = 0.029). The duration of stay was 7.07 ± 2.40 days in the control group and 5.13 ± 1.06 days in the octreotide and was found to be statistically significant (p = 0.010). No obvious adverse reactions related to injection octreotide, namely, nausea, vomiting, abdominal discomfort, hypotension, bradycardia, and dysglycemia, were seen in any of our patients. Conclusion The duration of lymphorrhea, incidence of seroma formation, and duration of hospital stay were lesser in the octreotide group, and the difference was statistically significant. The wound infection rates were similar in both groups. Thus injection octreotide can be used safely and effectively.
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Affiliation(s)
- Sahaj Prajapati
- Pediatric Surgery, Lady Hardinge Medical College, New Delhi, IND
| | | | - Manu Vats
- Surgery, Maulana Azad Medical College, New Delhi, IND
| | | | - Ketan Kantamaneni
- Surgery, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, IND
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van Zeelst LJ, Ten Wolde B, van Eekeren RRJP, Volders JH, de Wilt JHW, Strobbe LJA. Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort. J Surg Oncol 2021; 125:369-376. [PMID: 34786726 PMCID: PMC9298805 DOI: 10.1002/jso.26739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
Background An important complication following mastectomy is seroma formation. Quilting, in which skin flaps are sutured to the underlying muscle, is reported to reduce seroma incidence, but might induce pain and impair shoulder function. Main objective is to compare quilting with conventional wound closure, regarding seroma incidence, health care consumption, and patient discomfort. Methods In a combined prospective and retrospective study, 254 patients undergoing mastectomy and/or axillary lymph node dissection (ALND) were included. Patients received quilting sutures or conventional closure. Primary outcome was clinical significant seroma (CSS). In prospectively included patients shoulder function and analgesic use was observed. Results CSS incidence was 12.9% in the quilted versus 62.3% in the nonquilted cohort (p < 0.001). Surgical site infections were reported significantly less in the quilted cohort. Duration of hospital stay was shorter and outpatient clinic visits were less in the quilted cohort. Surgical procedure required 10 additional minutes for quilting. No significant differences were observed in postoperative shoulder function and analgesic use. Conclusion Quilting following mastectomy reduces CSS incidence. Quilting requires 10 additional minutes during surgery. It facilitates day treatment and results in less additional outpatient clinic visits culminating in reduced health care consumption. Shoulder function and pain are not affected by quilting.
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Affiliation(s)
- Lotte J van Zeelst
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Britt Ten Wolde
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - José H Volders
- Department of Surgical Oncology, Gelre Hospital, Apeldoorn, The Netherlands
| | | | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Effect of quilting on seroma formation in mastectomies: A meta-analysis. Surg Oncol 2021; 39:101665. [PMID: 34563996 DOI: 10.1016/j.suronc.2021.101665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Seroma is the most common complication following mastectomy and can require several days of drainage and lead to delayed wound healing, longer hospital stays, and an increased financial and emotional burden. Seroma formation is not well understood and but there is good evidence that closing the dead space via quilting can help reduce seroma formation. This study assessed randomized controlled trials and reviewed current literature to elucidate if there is a strong association between quilting sutures and seroma formation. METHODS A systematic search of 5 databases using search terms similar to "seroma", "quilting", "flap fixation", "random", and "mastectomy". Data was extracted and Medcalc software used to perform a meta-analysis of the primary outcome: incidence of seroma formation, as well as secondary outcomes: volume and duration of drainage. RESULTS Eleven randomized controlled trials with 2009 patients were included. Quilting with sutures greatly reduced the incidence of seroma formation compared with conventional closure (p < 0.001, RR 0.367 [95% CI 0.25, 0.539]; I2 = 63.56%) as well as duration of drainage (p = 0.015, SMD -1.657, SE 0.680 [95% CI -2.991, -0.324]; 8 studies, n = 1578; I2 = 98.98%). Quilting did not significantly affect volume of drainage. CONCLUSIONS Quilting was found to be associated with lower seroma rates. Future studies should investigate the use of quilting in combination with other preventative techniques to search for a synergistic method that will further improve patient care.
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Li Z, Qian B, Wang Z, Liu J, Wang B, Guo K, Sun J. Vertical Scar Versus Inverted-T Scar Reduction Mammaplasty: A Meta-Analysis and Systematic Review. Aesthetic Plast Surg 2021; 45:1385-1396. [PMID: 33649925 DOI: 10.1007/s00266-021-02167-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the vertical scar versus the Inverted-T scar reduction technique by comparing the postoperative complications and aesthetic effects. METHODS PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases for clinical studies were searched through June 30, 2019. Cumulative analysis was conducted using the Review Manager Version 5.3 software. The summary odds ratio (OR) was estimated using random effect models at 95% confidence intervals (CIs), statistical heterogeneity was tested using the Chi-square test and risk of bias was assessed using the Cochrane Handbook 5.1.0 and the Newcastle-Ottawa scale (NOS). RESULTS Two randomized controlled trials (RCT) and nine observational comparative studies were included. The vertical scar method was significantly lower than the Inverted-T scar method in overall incidence of complications (OR: 2.06; 95%CI, 1.15 to 3.70; P: 0.002) and wound dehiscence (OR: 4.62; 95%CI, 2.33 to 9.16; P<0.00001). No significant differences in seroma, hematoma, nipple necrosis, fat necrosis and reoperation were noted. CONCLUSIONS Both two breast reduction techniques are equally safe, while the vertical scar approach resulted in a statistically lower rate of overall complications and wound dehiscence. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Abstract
OBJECTIVES The most common method of performing breast reconstruction after a mastectomy is using tissue expanders. Significant drainage that can lead to seromas and possible infection is a common sequela after mastectomies, and therefore, closed suction drains are routinely placed during the initial surgery (Vardanian et al. Plast Reconstr Surg. 2011;128:403-410). Drains, however, are associated with increased pain and discomfort for the patient and have been attributed to an increased infection rate by some authors (Degnim et al. Ann Surg. 2013;258:240-247; Saratzis et al. Clin Breast Cancer. 2009;9:243-246). We report on our experience using a dual-chamber tissue expander placed in the prepectoral space without acellular dermal matrix or other supportive material, which allows for drainage of periprosthetic fluid and avoids drain placement. PATIENTS AND METHODS A retrospective, single-institution review of patients' records was performed for all patients who underwent prepectoral tissue expander placement between January 2018 and June 2019. Patients who had drains placed or who underwent autologous reconstruction in combination with expander placement were excluded. Thirty-nine patients were selected, with a total of 66 expander placements. Demographics including body mass index, comorbidities, history of smoking or steroid use, perioperative chemotherapy and radiation therapy, and intraoperative details and indications for surgery were retrospectively collected. Outcomes were separated into minor and major complications. Major complications were defined as complications that required surgical intervention. RESULTS There were 51 prepectoral reconstructions with a dual-chamber tissue expander and no further surgical drain and 15 reconstructions using a standard expander with an additional closed suction drain. Overall complications for the no-drain cohort were 13.7% compared with 20% in the drain cohort (P = 0.68). Surgical site infection rate is 7.84% in the no-drain cohort compared with 13.3% in the drain cohort (P = 0.61). Mean numeric postoperative pain score at 6 hours was 3.2 in the no-drain cohort compared with 4.3 in the drain cohort (P = 0.03) and 4.17 compared with 5.6 at 12 hours, respectively (P = 0.04). Mean time to exchange of implant in the no-drain cohort was 152 days versus 126 days in the drain cohort (P = 0.38). Median follow-up times were 157 days for the no-drain cohort and 347 days for the drain cohort. CONCLUSIONS Immediate breast reconstruction using a dual-chamber tissue expander offers a drain-free alternative to the immediate implant-based breast reconstruction. Our infection rate with 7.8% is lower than our own reported rates with subpectoral tissue expander reconstruction using either acellular dermal matrix or poly-4-hydroxybutyrate (17% and 11%). The overall complication rate is similar to historic data associated with breast reconstruction after mastectomy and suggests that dual-chamber expander placement offers a safe alternative possibly decreasing the patient's postoperative pain and discomfort that often is associated with closed suction drains (Saratzis et al. Clin Breast Cancer. 2009;9:243-246).
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Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis. Updates Surg 2021; 73:1307-1314. [PMID: 33886107 PMCID: PMC8397649 DOI: 10.1007/s13304-021-01049-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/02/2021] [Indexed: 11/09/2022]
Abstract
Seroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013). The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction.
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Deori A, Gupta N, Gupta AK, Yelamanchi R, Agrawal H, Durga CK. A Prospective Randomised Controlled Study Comparing Ultrasonic Dissector with Electrocautery for Axillary Dissection in Patients of Carcinoma Breast. Malays J Med Sci 2021; 28:97-104. [PMID: 33679225 PMCID: PMC7909355 DOI: 10.21315/mjms2021.28.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
Background Axillary dissection is one of the important components of modified radical mastectomy (MRM). The present study was conducted to compare surgical outcomes by using monopolar electrocautery and ultrasonic dissector for axillary dissection in MRM. Methods A parallel randomised controlled single blinded study was conducted with a sample size of 70 patients who were randomised into two groups. One group underwent MRM using ultrasonic dissector (Group A) and the other one using electrocautery (Group B). Intra- and post-operative outcomes were compared. Results Group A had an average operating time of 30.86 min, which was statistically less than that of Group B. The mean mop count and the daily drain output in Group A were less as compared to Group B and the differences were statistically significant. Drain was removed early in Group A as compared to Group B. However, post-operative pain scores and seroma formation were not statistically significant among the two groups. Conclusion Ultrasonic dissector group had significantly lesser intra-operative bleeding, operating time and post-operative drain output when compared to electrocautery group. However, the two groups had no significant difference in post-operative pain scores and seroma formation.
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Affiliation(s)
- Ananya Deori
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Nikhil Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arun Kumar Gupta
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Raghav Yelamanchi
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Himanshu Agrawal
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - C K Durga
- Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Novel Use of a Porcine Bladder Extracellular Matrix Scaffold to Treat Postoperative Seroma in a Total Knee Arthroplasty Patient. Arthroplast Today 2021; 7:143-147. [PMID: 33553541 PMCID: PMC7850943 DOI: 10.1016/j.artd.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
Seroma formation in a knee arthroplasty surgery is a rare complication. When seromas occur, they act as a nidus for bacterial growth and create an optimal environment for surgical site infections. In this case report, a 52-year-old woman presented with a seroma after multiple revision operations on the left knee. Owing to multiple failures of standard irrigation and drainage procedures to resolve the seroma, an orthoplastic colleague was consulted. Over five-and-a-half months, the patient underwent multiple procedures that failed to treat the seroma. However, in a final exploratory procedure, 3000 mg of urinary bladder matrix and negative pressure wound vacuum were placed. Seven months after the intervention, the patient had complete resolution.
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Wu S, Xin Z, Sui D, Ou Z, Bai H, Zhu S, Wang X, Zhang J. Development and validation of a nomogram to predict drainage duration in patients with breast cancer treated with modified radical mastectomy. Sci Rep 2021; 11:2533. [PMID: 33510284 PMCID: PMC7843610 DOI: 10.1038/s41598-021-82073-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
Appropriate drainage duration is vital for the postoperative rehabilitation of patients with breast cancer (BC) undergoing modified radical mastectomy (MRM). To provide better and individualized postoperative management for these patients, this study explored independent predictors of postoperative drainage duration in patients with BC. This was a single-center retrospective cohort study. Patients diagnosed with BC and treated with MRM from May 2016 to April 2020 were randomly divided into training (n = 729) and validation (n = 243) cohorts. Univariate and multivariate Cox analyses revealed that the body mass index, serum albumin level, hypertension, number of total dissected axillary lymph nodes, and ratio of positive axillary lymph nodes were independent predictors of postoperative drainage duration in the training cohort. Based on independent predictors, a nomogram was constructed to predict the median postoperative drainage duration and the probability of retaining the suction drain during this period. This nomogram had good concordance and discrimination both in the training and validation cohorts and could effectively predict the probability of retaining the suction drain during drainage, thus assisting clinicians in predicting postoperative drainage duration and providing individualized postoperative management for patients with BC.
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Affiliation(s)
- Song Wu
- Department of Thyroid and Breast Surgery, The First People's Hospital of Wenling, Wenling, Zhejiang, China
| | - Zechang Xin
- Dalian Medical University, Dalian, Liaoning, China
| | - Daxing Sui
- Dalian Medical University, Dalian, Liaoning, China
| | - Zhengli Ou
- Dalian Medical University, Dalian, Liaoning, China
| | - Haotian Bai
- Dalian Medical University, Dalian, Liaoning, China
| | - Shenzhen Zhu
- Dalian Medical University, Dalian, Liaoning, China
| | - Xueying Wang
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou University Medical Academy, Yangzhou, 225001, Jiangsu, China
| | - Jiaxin Zhang
- Department of Thyroid and Breast Surgery, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou University Medical Academy, Yangzhou, 225001, Jiangsu, China.
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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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de Rooij L, van Kuijk SMJ, Granzier RWY, Hintzen KFH, Heymans C, Theunissen LLB, von Meyenfeldt EM, van Essen JA, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. Reducing Seroma Formation and Its Sequelae After Mastectomy by Closure of the Dead Space: A Multi-center, Double-Blind Randomized Controlled Trial (SAM-Trial). Ann Surg Oncol 2020; 28:2599-2608. [PMID: 33078318 DOI: 10.1245/s10434-020-09225-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Seroma is a common complication after mastectomy, with an incidence of 3% to 85%. Seroma is associated with pain, delayed wound healing, and additional outpatient clinic visits, leading potentially to repeated seroma aspiration or even surgical interventions. This study aimed to assess the effect of flap fixation using sutures or tissue glue in preventing seroma formation and its sequelae. METHODS Between June 2014 and July 2018, 339 patients with an indication for mastectomy or modified radical mastectomy were enrolled in this randomized controlled trial in the Netherlands. Patients were randomly allocated to one of the three following arms: conventional wound closure (CON, n = 115), flap fixation using sutures (FFS, n = 111) or flap fixation using tissue glue (FFG, n = 113). The primary outcome was the need for seroma aspiration. The secondary outcomes were additional outpatient department visits, surgical-site infection, shoulder function and mobility, cosmesis, skin-dimpling, and postoperative pain scores. RESULTS Flap fixation after mastectomy leads to fewer seroma aspirations than conventional wound closure (CON 17.5% vs FFS 7.3% vs FFG 10.8%; p = 0.057), with a significant difference between flap fixation with sutures and conventional wound closure (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16-0.89; p = 0.025). Flap fixation has no significant negative effect on surgical-site infections, shoulder function and mobility, cosmesis, skin-dimpling, or postoperative pain. CONCLUSION Flap fixation using sutures leads to a significant reduction in aspirations of post-mastectomy seromas. The authors strongly advise surgeons to use sutures for flap fixation in patients undergoing mastectomy. (ClinicalTrials.gov no. NCT03305757). PREREGISTRATION The trial was registered after enrollment of the first participant. However, no specific explanation exists for this except that through the years more importance has been given to central trial registration. Our research team can ensure that after enrollment of the first participant, no changes were made to the trial, analysis plan, and/or study design.
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Affiliation(s)
- L de Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R W Y Granzier
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - K F H Hintzen
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - C Heymans
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - L L B Theunissen
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - E M von Meyenfeldt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J A van Essen
- Department of Surgery, St. Jans Gasthuis Hospital, Weert, The Netherlands
| | - E R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - A Janssen
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
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De Rooij L, Bosmans JWAM, van Kuijk SMJ, Vissers YLJ, Beets GL, van Bastelaar J. A systematic review of seroma formation following drain-free mastectomy. Eur J Surg Oncol 2020; 47:757-763. [PMID: 33051116 DOI: 10.1016/j.ejso.2020.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/14/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Seroma is a common complication after mastectomy. The aim of this review is to elucidate whether closed suction drainage can safely be omitted in patients undergoing mastectomy when assessing seroma formation and its complications. The second aim is to assess the influence of flap fixation on seroma related complications, as there is existing evidence showing that combining mastectomy with flap fixation may make the use of drainage systems obsolete. SEARCH & SELECTION A review of the literature was performed and articles that compared mastectomy with drainage and mastectomy without drainage were selected. Due to the small number of eligible studies, no selection based on whether flap fixation was performed was possible. If outcome was described in terms of seroma formation or seroma related complications, papers were eligible for inclusion. Studies older than 20 years, animal studies, studies not written in English and studies with male patients were excluded. RESULTS A total of eight articles were eligible for inclusion. Four prospective studies and four retrospective studies were included. In four studies, flap fixation was performed. Frequency of seroma formation as well as seroma that required intervention was reported. The included studies demonstrated that omitting closed suction drainage does not lead to a higher incidence of seroma formation in patients undergoing mastectomy. CONCLUSION Despite substantial heterogeneity, there is evidence that drainage can safely be omitted without exacerbating seroma formation and its complications. A well-powered, randomized controlled trial evaluating the effect of drainage omission on seroma formation, with or without flap fixation, is needed.
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Affiliation(s)
- L De Rooij
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands.
| | - J W A M Bosmans
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y L J Vissers
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
| | - G L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Center, Sittard, the Netherlands
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de Rooij L, van Kuijk SMJ, van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J. A single-center, randomized, non-inferiority study evaluating seroma formation after mastectomy combined with flap fixation with or without suction drainage: protocol for the Seroma reduction and drAin fRee mAstectomy (SARA) trial. BMC Cancer 2020; 20:735. [PMID: 32767988 PMCID: PMC7412663 DOI: 10.1186/s12885-020-07242-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Seroma formation is a common complication after breast cancer surgery and can lead to delayed wound healing, infection, patient discomfort and repeated visits to the outpatient clinic. Mastectomy combined with flap fixation is becoming standard practice and is currently combined with closed-suction drainage. There is evidence showing that closed-suction drainage may be insufficient in preventing seroma formation. There is reasonable doubt whether there is still place for closed-suction drainage after mastectomy when flap fixation is performed. We hypothesize that mastectomy combined with flap fixation and closed suction drainage does not cause a significant lower incidence of seroma aspirations, when compared to mastectomy and flap fixation alone. Furthermore, we expect that patients without drainage will experience significantly less discomfort and comparable rates of surgical site infections. METHODS This is a randomized controlled trial in female breast cancer patients undergoing mastectomy and flap fixation using sutures with or without sentinel lymph node biopsy (SLNB). Patients will be eligible for inclusion if they are older than 18 years, have an indication for mastectomy with or without sentinel procedure. Exclusion criteria are modified radical mastectomy, direct breast reconstruction, previous history of radiation therapy of the unilateral breast, breast conserving therapy and inability to give informed consent. A total of 250 patients will be randomly allocated to one of two groups: mastectomy combined with flap fixation and closed-suction drainage or mastectomy combined with flap fixation without drainage. Follow-up will be conducted up to six months postoperatively. The primary outcome is the proportion of patients undergoing one or more seroma aspirations. Secondary outcome measures consist of the number of invasive interventions, surgical site infection, quality of life measured using the SF-12 Health Survey, cosmesis, pain and number of additional outpatient department visits. DISCUSSION To our knowledge, no randomized controlled trial has been conducted comparing flap fixation with and without closed-suction drainage with seroma aspiration as the primary outcome. This study could result in finding evidence that supports performing mastectomy without closed-suction drainage. TRIAL REGISTRATION This trial was approved by the medical ethical committee of Zuyderland Medical Center METC-Z on 20 March 2019 (METCZ20190023). The SARA Trial was registered at ClinicalTrials.gov as per July 2019, Identifier: NCT04035590 .
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Affiliation(s)
- Lisa de Rooij
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Els R M van Haaren
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
| | - Alfred Janssen
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Postbus 5500, 6130, MB, Sittard, 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 Center, Postbus 5500, 6130, MB, Sittard, the Netherlands
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Wu Y, Wang S, Hai J, Mao J, Dong X, Xiao Z. Quilting suture is better than conventional suture with drain in preventing seroma formation at pectoral area after mastectomy. BMC Surg 2020; 20:65. [PMID: 32252732 PMCID: PMC7137264 DOI: 10.1186/s12893-020-00725-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to compare quilting suture with conventional suture on the formation of seroma at pectoral area after mastectomy (ME) with sentinel lymph nodes biopsy (SLN) or axillary lymph nodes dissection (ALND) for breast cancer. METHODS Two hundred thirty-five consecutive breast cancer patients were retrospectively analyzed. The primary outcome was the incidence of Grade 2 or Grade 3 seroma at anterior pectoral area within 1 month postoperatively. We categorized seroma into early or late seroma according to the drainage removal time. Cox regression was used for analysis. RESULTS The incidence of Grade 2 and 3 seroma was significantly higher in the conventional suture group compared with that in the quilting suture group (19.3% vs. 9.5%, p = 0.032), which was attributed to the late seroma in Grade 2 and 3. Quilting suture was associated with longer time for fixing flaps compared with that of conventional suture (504.7 s vs. 109.1 s, p < 0.001), but with less volume of drainage. Old age, high body mass index and conventional suture were independently risk factors for Grade 2 and 3 seroma. CONCLUSIONS Quilting suture decreased the incidence of Grade 2 and 3 seroma at pectoral area within 1 month after mastectomy, especially the late seroma in Grade 2 and 3.
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Affiliation(s)
- Yuhui Wu
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Shouman Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Jian Hai
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Jie Mao
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Xue Dong
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008
| | - Zhi Xiao
- Department of Breast Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, P. R. China, 410008. .,Clinical Research Center For Breast Cancer Control and Prevention In Human Province, Changsha, P. R. China.
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Steinthorsdottir KJ, Awada HN, Abildstrøm H, Kroman N, Kehlet H, Kvanner Aasvang E. Dexamethasone Dose and Early Postoperative Recovery after Mastectomy. Anesthesiology 2020; 132:678-691. [DOI: 10.1097/aln.0000000000003112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol.
Methods
In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections.
Results
One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217).
Conclusions
The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Affiliation(s)
- Kristin Julia Steinthorsdottir
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
| | - Hussein Nasser Awada
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
| | - Hanne Abildstrøm
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
| | - Niels Kroman
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
| | - Henrik Kehlet
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
| | - Eske Kvanner Aasvang
- From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K
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Sclerotherapy With OK-432 for the Treatment of Symptomatic Lymphocele After Lymph Node Dissection. Ann Plast Surg 2020; 85:407-412. [DOI: 10.1097/sap.0000000000002251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oultram S, Dempsey S, Greer P, Clapham M. Comparing Breast Conservation Surgery Seromas Contoured by Radiation Therapists versus those Contoured by a Radiation Oncologist in Radiation Therapy Planning for Early-Stage Breast Cancer. J Med Imaging Radiat Sci 2020; 51:108-116. [PMID: 31983574 DOI: 10.1016/j.jmir.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the management of early-stage breast cancer using radiation therapy, computed tomography (CT) simulation is used to identify the breast conservation surgery (BCS) seroma as a proxy for the tumour bed. The delineation or contouring of the seroma is generally a task performed by a radiation oncologist (RO). With increasing patient numbers and other demands placed on ROs, the scope of practice for radiation therapists (RTs) is continually expanding, and the need for skills transfer from one profession to another has been investigated in recent years. This study aims to compare the BCS seroma volumes contoured by RTs with those contoured by ROs to add evidence in support of expanding the RTs' role in the treatment planning process in the management of early-stage breast cancer. METHODS A study was undertaken using the CT-simulation (CT-sim) data sets of patients with early-stage breast cancer treated in 2013. The CT-sim data sets had BCS seromas contoured by 1 of 5 ROs as part of routine clinical management. This study involved 4 RTs who each used the patient information to identify and contour breast seromas on 50 deidentified CT-sim data sets. Metrics used to compare RT versus RO contours included volume size, overlap between volumes, and geographical distance from the centre of volumes. RESULTS There were 50 CT-sim data sets with 1 RO contour and 4 RT contours analysed. The contour volumes of the 4 RTs and the ROs were assessed. Although there were 50 CT-sim data sets presented to each RT, analysis was carried out on 45, 43, 46, and 45 CT-sim data sets. There were no comparisons made where contours were not delineated. The contour volumes of the 4 RTs and the ROs were assessed with an interclass correlation coefficient, with a result of excellent reliability (0.975, 95% [0.963, 0.985]). The DICE similarity coefficient was used to compare the overlap of each RT contour with the RO contour; the results were favourable with mean (95% CI) DSCs 0.685, 0.640, 0.678, and 0.681, respectively. Comparing the RT and RO geographical centre of the seroma volumes, good to excellent reliability between the RTs and ROs was demonstrated (95% CI mean RO vs RT distances (mm): 3.75, 4.99, 7.71, and 3.39). There was no statistically significant difference between the distances (P = 0.65). CONCLUSION BCS seromas contoured by RTs compared well with those contoured by an RO. This research has provided further evidence to support RTs in assuming additional contouring responsibilities in radiation therapy planning for patients with early-stage breast cancer.
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Affiliation(s)
- Sharon Oultram
- Senior Clinical Radiation Therapy Educator, MPhil (Research) Candidate, Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
| | - Shane Dempsey
- Head of School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Matthew Clapham
- Clinical Research Design, IT, and Statistical Support (CReDITTS), Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
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Arnica montana and Bellis perennis for seroma reduction following mastectomy and immediate breast reconstruction: randomized, double-blind, placebo- controlled trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chen K, Sinelnikov MY, Nikolenko VN, Reshetov IV, Cao Y, Li Z, Kochurova EV, Nikolenko SN, Avila-Rodríguez M, Somasundaram SG, Kirkland CE, Aliev G. The Use of Fibrin-based Tissue Adhesives for Breast in Reconstructive and Plastic Surgery. Curr Top Med Chem 2020; 19:2985-2990. [DOI: 10.2174/1568026619666191112101448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
Background:Breast plastic surgery is a rapidly evolving field of medicine. The modern view of surgical trends reflects the desire to minimize complications and introduce advanced technologies. These always will be priorities for surgeons. Reconstructive surgery, a branch of plastic surgery focusing on restoration of lost functional and aesthetic component, seeks to enhance psychological rehabilitation and improves the quality of life, as well as aesthetic recovery.Objective:This review addresses the action of fibrin agents and their effect on the quality of surgical hemostasis.Discussion and Conclusion:The fundamental goals for the surgeon are to perform a minimally traumatic intervention and to prevent any form of complication. Achieving complete hemostasis is an intraoperative necessity. Timely prevention of bleeding and hemorrhagic phenomena can affect not only the outcome of the operation, but also the incidence of postoperative complications. Topics include the integrity of microvascular anastomoses, tissue adhesion, and the incidence of seromas and hematomas associated with fibrin glue usage. The literature on fibrin adhesives with respect to prevention of postoperative complications, and the effectiveness with active drainage also are analyzed.
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Affiliation(s)
- Kuo Chen
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Mikhail Y. Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Vladimir N. Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Igor V. Reshetov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Yu Cao
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Zhi Li
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Ekaterina V. Kochurova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Svetlana N. Nikolenko
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
| | - Marco Avila-Rodríguez
- Department of Clinical Sciences, Faculty of Health Sciences, University of Tolima, Ibagué –730001, Colombia
| | - Siva G. Somasundaram
- Department of Biological Sciences, Salem University, 223 West Main Street Salem, WV 26426, United States
| | - Cecil E. Kirkland
- Department of Biological Sciences, Salem University, 223 West Main Street Salem, WV 26426, United States
| | - Gjumrakch Aliev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str., Moscow 119991, Russian Federation
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Reducing seroma formation and its sequelae after mastectomy by closure of the dead space: The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial). Breast 2019; 46:81-86. [DOI: 10.1016/j.breast.2019.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/16/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022] Open
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Jackson PC, MacInnes EG, Nicholson JK, Brayshaw I, Relton S, Achuthan R. Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome. Cureus 2019; 11:e5160. [PMID: 31528512 PMCID: PMC6743667 DOI: 10.7759/cureus.5160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Use of drains after mastectomy remains highly variable. This study aimed to establish whether simple mastectomy managed without a drain would cost less than the same procedure managed with a drain and whether there would be any difference in complications. Methods Prospective data were collected on all patients undergoing simple mastectomy ± sentinel lymph node biopsy over sixteen months. Surgeons decided intra-operatively whether to place a drain. Data included operative details, mastectomy weight, length of stay and postoperative complications. Costing data were identified by combining hospital finance costs for admission and follow-up appointments along with the cost of consumables. Results One hundred and thirty mastectomies were performed on 119 patients. There was a significant difference in mastectomy weight between drain group patients (n=80, median: 730g) and no drain group patients (n=50, median: 424g) (p=<0.001). The mean cost for drain group patients was £639.77 whilst for the no drain group was £365.46, indicating a potential unit saving of £21944.93 over sixteen months. Length of stay was shorter in the no drain group (range: 1-2 days) than the drain group (range: 1-4 days). The presence or absence of drains did not influence complication rates, with no change in seroma interventions (p=0.803). Conclusions Managing simple mastectomy patients without a drain resulted in no increase in complications or subsequent interventions for seroma. Significant cost savings to both the hospital and to the patient can be achieved by omitting drain use. Routine use of drains in patients undergoing simple mastectomy ± SNB may be unnecessary and costly.
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Affiliation(s)
| | | | | | - Ian Brayshaw
- Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR
| | - Samuel Relton
- Miscellaneous, Leeds Institute of Health Sciences, The University of Leeds, Leeds, GBR
| | - Raj Achuthan
- Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR
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Michalik T, Matkowski R, Biecek P, Szynglarewicz B. The use of ultrasonic scalpel lowers the risk of post-mastectomy seroma formation in obese women. J Cancer 2019; 10:3481-3485. [PMID: 31293652 PMCID: PMC6603425 DOI: 10.7150/jca.29774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/05/2019] [Indexed: 01/18/2023] Open
Abstract
Introduction: Seroma formation (SF) is the most common postoperative complication after mastectomy and axillary surgery. The aim of this study was to assess its incidence and risk factors following a modified radical mastectomy in breast cancer patients. Materials and methods: 271 patients who underwent a modified radical mastectomy (250 with traditional electrocautery and 21 with an ultrasonic scalpel) were studied. The SF rate was calculated and its association with patient-related factors, surgical features and postoperative variables was assessed and statistically analyzed with P<0.05 as a significance threshold. Results: SF was observed in 18% of patients. Patient's age, operating time and number of removed axillary lymph nodes did not significantly differ between SF and non-SF patients. Patients BMI, total drainage amount, number of days with drain were higher and postoperative hospital stay was significantly longer in SF patients (P<0.001 each). The dissection instrument was also an important risk factor: SF developed in 20% of patients operated with electrocautery and in none with an ultrasonic scalpel (P<0.05). The association between surgical instrument and the number of removed lymph nodes, patient's age and BMI was not significant. Dissection with an ultrasonic scalpel resulted in a statistically significant lower total drainage amount. However, it was also related to a significantly longer operating time (P<0.001 each). Conclusions: Risk of SF after a modified radical mastectomy is significantly higher in patients with obesity. Despite longer operating time, using an ultrasonic scalpel is a valuable option in those cases because it lowers the total drainage amount and seems to be an important protective factor against SF.
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Affiliation(s)
- Tomasz Michalik
- Breast Unit, Lower Silesian Oncology Center - Regional Comprehensive Cancer Center, Plac Hirszfelda 12, 53-413 Wroclaw, Poland
| | - Rafal Matkowski
- Breast Unit, Lower Silesian Oncology Center - Regional Comprehensive Cancer Center, Plac Hirszfelda 12, 53-413 Wroclaw, Poland.,Department of Oncology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Plac Hirszfelda 12, 53-413 Wroclaw, Poland
| | - Przemyslaw Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
| | - Bartlomiej Szynglarewicz
- Breast Unit, Lower Silesian Oncology Center - Regional Comprehensive Cancer Center, Plac Hirszfelda 12, 53-413 Wroclaw, Poland.,Department of Oncology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Plac Hirszfelda 12, 53-413 Wroclaw, Poland
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ten Wolde B, Strobbe FFR, Schlooz-de Vries M, van den Wildenberg FJH, Keemers-Gels M, de Wilt JHW, Strobbe LJA. Omitting Postoperative Wound Drainage After Mastectomy With Skin-Flap Quilting. Ann Surg Oncol 2019; 26:2773-2778. [DOI: 10.1245/s10434-019-07411-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 11/18/2022]
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50
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Saner FA, Schötzau A, Mackay G, Heinzelmann-Schwarz V, Montavon Sartorius C. Fibrin-thrombin sealant does not reduce lymphocele formation in patients with inguinofemoral lymphadenectomy for vulvar cancer. Cancer Manag Res 2019; 11:3575-3582. [PMID: 31118780 PMCID: PMC6503303 DOI: 10.2147/cmar.s197143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/19/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose: Inguinofemoral lymphadenectomy (IFLD) is associated with very high morbidity. Fibrin sealant patches are used in various surgical procedures to prevent hematomas and lymphoceles. Here, we report a single-institution experience of fibrin sealants after IFLD in vulvar cancer and give an overview of the current literature. Patients and methods: We retrospectively analyzed outcome data on vulvar cancer patients who underwent bilateral IFLD between November 2014 and June 2016 at the University Hospital Basel. A fibrin sealant patch (Tachosil®) was placed in one groin only. Postsurgical fluid collection and complications were compared between both groins; time courses of lymphocele formation were analyzed using a linear mixed-effects regression model. Results: Postsurgical outcome of 11 consecutive patients with bilateral IFLD for vulvar cancer was assessed for a median follow-up of 32 days (range 12–77). Significantly larger lymphoceles were detected over time in the groin with the fibrin sealant patch (median 20 mL vs 5 mL without patch, p=0.002), and more punctures for symptomatic lymphocele were required on this side. The infection rate did not differ between sides. Conclusion: Fibrin sealant patches should not routinely be used for prevention of lymphoceles after IFLD for vulvar cancer. They do not seem to reduce lymph collection, the need for puncture or the infection risk after lymphadenectomy in our experience and according to a general literature review.
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Affiliation(s)
- Flurina Am Saner
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Schötzau
- Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gillian Mackay
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland.,Ovarian Cancer Research, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Céline Montavon Sartorius
- Department of Gynecology and Gynecological Oncology, Hospital for Women, University Hospital Basel and University of Basel, Basel, Switzerland
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