1
|
Sanjeeviah RC, Bandimegal M, Patil V, Telkar KG, Gowda NS. Povidone Iodine Sclerotherapy for the Treatment of Persistent Seromas after Breast Cancer Surgery. Indian J Surg Oncol 2023; 14:81-87. [PMID: 36891446 PMCID: PMC9986158 DOI: 10.1007/s13193-022-01629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/18/2022] [Indexed: 10/15/2022] Open
Abstract
Persistent seroma following breast cancer surgery causes morbidity and delays adjuvant treatment. Sclerotherapy helps in managing recalcitrant seromas. We evaluated efficacy of 10% povidone iodine sclerotherapy treatment for persistent seromas after breast cancer surgery. Persistent drainage of > 100 mL/day 15 days following surgery, and seromas that required aspiration > 100 mL/week 2 weeks after drain removal, was considered for 10% povidone sclerotherapy in a non-randomized observational study. Resolution (drain output < 20 mL/day), treatment days, recurrence, and complications were assessed as measures of efficacy. Descriptive measures of central tendency and dispersion were reported. The relationship of the seroma quantity with risk factors (age, body mass index, levels and number of axillary lymph nodes dissected, neoadjuvant chemotherapy) and efficacy was analysed. We examined the correlation using Pearson and Spearman' signed rank, Student's t, and Mann-Whitney U-tests, to compare the means. Of 14/312 (4.5%) patients with persistent seroma, 13 (92.8%) had complete resolution after sclerotherapy within 6.71 days (range: 6-8). AC (p = 0.04), neoadjuvant chemotherapy (NACT) (p = 0.005), and number of nodes harvested without NACT (p = 0.025) were significantly associated with the quantity of discharge, while age (p = 0.072), body mass index (p = 0.432), type of surgery (breast conservation surgery vs. modified radical mastectomy) (p = 0.28), and total number of axillary lymph nodes (p = 0.679) were not. When used in this unique innovative manner, 10% povidone iodine sclerotherapy was found to be very effective (93%), minimally invasive, and safe in our study, and therefore appears to be an ideal sclerosing agent. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01629-0.
Collapse
Affiliation(s)
- Ravinder Chowrappa Sanjeeviah
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Mahesh Bandimegal
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Vijayraj Patil
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Kanmani Govindrao Telkar
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| | - Naveen Shivanna Gowda
- Department of Surgical Oncology, Ground Floor, Health Care Global (HCG) Cancer Hospital, OPD no: 3, Tower 3, Kalinga Rao Road, 560027 Sampangiramanagar, Bangalore, India
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
3
|
Yilmaz S, Aykota MR, Baran TY, Sabir N, Erdem E. Randomised controlled study of seroma rates after mastectomy with and without quilting the skin flap to pectoralis muscle. Niger J Clin Pract 2021; 24:1779-1784. [PMID: 34889785 DOI: 10.4103/njcp.njcp_16_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims The aim of this study was to determine whether seroma formation was affected by reduction of the potential dead space with the flap fixation method and obliteration of the axillary region in patients with breast cancer who underwent either mastectomy and axillary lymph node dissection or sentinel lymph node biopsy. A total of 105 patients with breast cancer were divided into two groups according to wound closure patterns. Patients and Methods The operating time, postoperative pain and complications, time to drain removal, seroma formation, amount of fluid aspirated and number of aspirations were recorded prospectively. Results No significant difference was found between groups in the rates of seroma development (P = 0.7), complication rates (P = 0.6), time to drain removal (P = 0.5), length of hospital stay (P = 0.3) or numbers of aspiration (P = 0.7). The operating time for fixation was determined to be longer than that of the classic procedure (P = 0.02). Conclusions Reducing potential dead space with flap fixation and obliteration of the axillary region may be useful in decreasing the development of seroma in patients who have undergone mastectomy because of breast cancer. However, surgical technique must be careful, and appropriate patient follow-up must be conducted.
Collapse
Affiliation(s)
- S Yilmaz
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - M R Aykota
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - T Y Baran
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - N Sabir
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - E Erdem
- Department of General Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
5
|
Murugesan A. Cost-effective, Clean, Absorbent Dressings for Wounds with Copious Lymphorrhoea. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
6
|
Irie Y, Obinata D, Tsukada J, Arakawa S, Kadotani M, Hori Y, Yoshizawa T, Mochida J, Yamaguchi K, Takahashi S. Successful lymphatic embolization using N-butyl-2-cyanoacrylate for postoperative lymphorrhea in a patient with renal pelvic cancer. Radiol Case Rep 2020; 15:2139-2143. [PMID: 32952751 PMCID: PMC7484521 DOI: 10.1016/j.radcr.2020.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
We present a successful case of percutaneous lymphatic embolization using N-butyl-2-cyanoacrylate (NBCA) for postoperative lymphorrhea in a patient with urothelial carcinoma of renal pelvis. A 75-year-old man with urothelial carcinoma of left renal pelvis with para-aortic lymph nodes metastases. The patient presented severe lymphorrhea after neo-adjuvant chemotherapy followed by laparoscopic total left nephroureterectomy and lymph nodes dissection. Since conservative treatments were ineffective, percutaneous lymphatic embolization using NBCA resulted in healing of the lymphorrhea without recurrence. Percutaneous lymphatic embolization using NBCA followed by intranodal lymphography is a powerful treatment option for intractable postoperative lymphorrhea after lymph nodes dissection.
Collapse
|
7
|
Vettuparambil A, Subramanya C. Flap Fixation as a Technique for Reducing Seroma Formation in Patients Undergoing Modified Radical Mastectomy: an Institutional Experience. Indian J Surg Oncol 2020; 12:48-53. [PMID: 33814831 DOI: 10.1007/s13193-020-01220-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022] Open
Abstract
Formation of seroma most frequently occurs after mastectomy and axillary surgery. This study is intended at creating data on whether flap fixation has any role in reducing the seroma formation in patients undergoing the modified radical mastectomy. A prospective comparative study was conducted among 61 patients scheduled for modified radical mastectomy from 1st of January 2017 to 31st of December 2017. Patients were divided into two groups. In the flap fixation group (N = 30), the skin flaps were sutured to the pectoral muscle with Vicryl 3-0 sutures, and in the control group (N = 31), the wound was closed in the conventional methods at the edges. Closed suction drain was used in both groups. Flap fixation group showed a significantly lower frequency of seroma formation compared with the control group. In the flap fixation group, the drain was removed earlier compared with the control group. Mean value of the total amount of fluid drained for the study group was significantly lower than that of control. Flap fixation is a surgical technique which appears to reduce the total volume of fluid drained, the development of seroma, and the need for seroma aspirations.
Collapse
Affiliation(s)
- Ajith Vettuparambil
- Department of surgery, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala 673577 India
| | - Chandrashekar Subramanya
- Department of General Surgery, Mysore Medical College and Research Institute, Mysore, Karnataka 570001 India
| |
Collapse
|
8
|
Yang JC, Yen YH, Wu SC, Lin WC, Chiang MH, Hsieh CH. Supermicrosurgical Lymphaticovenous Anastomosis as an Alternative Treatment Option for Patients with Lymphorrhea. Plast Reconstr Surg 2019; 144:1214-24. [PMID: 31688769 DOI: 10.1097/PRS.0000000000006169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive. METHODS From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors' hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post-lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded. RESULTS No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green-enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent). CONCLUSION With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
9
|
Suarez-Kelly LP, Pasley WH, Clayton EJ, Povoski SP, Carson WE, Rudolph R. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer 2019; 19:99. [PMID: 30674296 PMCID: PMC6345065 DOI: 10.1186/s12885-019-5293-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Background Seroma formation is the most common complication after mastectomy and places patients at risk of associated morbidities. Microporous polysaccharide hemospheres (MPH) consists of hydrophilic, plant based, polysaccharide particles and is currently used as an absorbable hemostatic agent. An animal model evaluating MPH and seroma formation after mastectomy with axillary lymph node dissection showed a significant decrease in seroma volume. Study aim was to evaluate topical MPH on the risk of post-mastectomy seroma formation as measured by total drain output and total drain days. Methods Prospective randomized single-blinded clinical trial of patients undergoing mastectomy for the treatment of breast cancer. MPH was applied to the surgical site in the study group and no application in the control group. Results Fifty patients were enrolled; eight were excluded due to missing data. Forty-two patients were evaluated, control (n = 21) vs. MPH (n = 21). No difference was identified between the two groups regarding demographics, tumor stage, total drain days, total drain output, number of clinic visits, or complication rates. On a subset analysis, body mass index (BMI) greater than 30 was identified as an independent risk factor for high drain output. Post hoc analyses of MPH controlling for BMI also revealed no statistical difference. Conclusions Unlike the data presented in an animal model, no difference was demonstrated in the duration and quantity of serosanguinous drainage related to the use of MPH in patients undergoing mastectomy for the treatment of breast cancer. BMI greater than 30 was identified as an independent risk factor for high drain output and this risk was not affected by MPH use. NCT03647930, retrospectively registered 08/2018.
Collapse
Affiliation(s)
- Lorena P Suarez-Kelly
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA. .,The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA.
| | - W Hampton Pasley
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Eric J Clayton
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| | - Stephen P Povoski
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - William E Carson
- The Arthur G. James Comprehensive Cancer Center and Solove Research Institute, The Ohio State University, 424 Wiseman Hall, 410 W. 12th Ave, Columbus, OH, 43210, USA
| | - Ray Rudolph
- Memorial University Medical Center, 4700 Waters Ave, Savannah, GA, 31404, USA
| |
Collapse
|
10
|
Besler E, Harmancıoğlu Ö. Examination of the Effects of Celecoxib on Postmastectomy Seroma and Wound Healing. Sisli Etfal Hastan Tip Bul 2018; 52:212-9. [PMID: 32595401 DOI: 10.14744/SEMB.2018.66933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 01/13/2023]
Abstract
Objectives: To examine the effect of celecoxib on wound healing and development of seroma after mastectomy. Seroma is an accumulation of serous fluid in dead space emerging after breast cancer surgery. The pathophysiology of seroma has not been clearly elucidated. Development of seroma leads to prolongation of hospital stay, increase in costs, ischemia of the flaps, infections due to fluid accumulation, and delayed adjuvant treatment. Seroma is still a current problem, and the most common treatment method for this problem is drainage and repeated aspirations for 5–7 days after surgery. Methods: The effect of celecoxib whose anti-inflammatory, antiangiogenic, and antioxidant effectiveness has been demonstrated in a mastectomy model applied on female Wistar rats has been investigated in the present study. A total of 20 rats including 10 rats in the control and 10 in the celecoxib group were studied. Intraperitoneal 0.25 cc/250 g (20 mg/kg/day) celecoxib was administered to the celecoxib group for 5 days after mastectomy, and the same volume of physiological saline solution was given to the control group for 5 days. Rats were followed up for 10 days after surgery. During this process, vitality of the rats, movements of the extremities, wound healing conditions, wound infections, flap necrosis, and occurrence of seroma were recorded. At the end of this period, seromas were aspirated, tissue samples were retrieved, and the rats were sacrificed. Fibrin, hemorrhage, edema, vascularization, congestion, polymorphonuclear leukocytes, and increase in fibrotic tissue fibroblasts, lymphocytes, and macrophages were evaluated in tissue samples. In seroma fluids, interleukin-1 beta (IL-1β), an acute phase reactant, and vascular endothelial growth factor, a vital parameter of vascular proliferation and angiogenesis, were examined. Results: At the end of the experiments, the seroma volume decreased significantly in the celecoxib group (p=0.804; 0.001), the IL-1β level decreased significantly as detected in the biochemical examination (p=0.014), and in the histopathological examination, an increase in congestion in the celecoxib group was determined. Conclusion: In conclusion, celecoxib markedly decreased interleukin and the volume of seroma after mastectomy; suppressed the level of an acute phase reactant, IL-1β; and demonstrated this effect through its anti-inflammatory activity. We believe that the effects of celecoxib should be investigated using different dose applications and larger number of subjects.
Collapse
|
11
|
Ohkura Y, Ueno M, Shindoh J, Iizuka T, Ka H, Udagawa H. Risk Factors for Postoperative Chylothorax After Radical Subtotal Esophagectomy. Ann Surg Oncol 2018; 25:2739-2746. [PMID: 29998406 DOI: 10.1245/s10434-018-6640-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chylothorax is one of the complications of esophagectomy for esophageal cancer. The treatment of this condition has been well discussed, but the risk factors for postoperative chylothorax remain unclear. METHODS A retrospective review of 294 patients who underwent esophagectomy for esophageal cancer was conducted. These were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I tumor of the esophagogastric junction who underwent subtotal esophagectomy with two-field or three-field lymphadenectomy. Of these, 24 patients who were diagnosed with chylothorax as a postoperative complication were allocated to the chylothorax group and the other 270 patients were allocated to the nonchylothorax group. RESULTS Univariate analysis showed a significant difference in three factors: resection of thoracic duct, post-chemoradiotherapy, and high intraoperative fluid balance. Multivariate analysis revealed that post-chemoradiotherapy [hazard ratio (HR) = 3.430; 95% confidence interval (CI) 1.364-8.625] and high intraoperative fluid balance (HR = 1.569; 95% CI 1.2.7-2.039) were independent factors predicting chylothorax. In addition, resection of the thoracic duct may be a predictor of chylothorax after esophagectomy (HR = 3.389; 95% CI 0.941-12.201, p = 0.062). Receiver operating characteristic curve analysis of intraoperative fluid revealed that the sensitivity was 62.5%, specificity was 74.1%, and the cutoff value was 6.55 mL/kg/h. CONCLUSIONS This study revealed that post-chemoradiotherapy and high intraoperative fluid balance are predictors of chylothorax after esophagectomy. The elucidation of clinicopathological factors that can predict the incidence of chylothorax will help to establish more effective perioperative management for esophageal cancer patients.
Collapse
Affiliation(s)
- Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Junichi Shindoh
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Hairin Ka
- Department of Anesthesiology, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| |
Collapse
|
12
|
Gasparri ML, Ruscito I, Bolla D, Benedetti Panici P, Mueller MD, Papadia A. The Efficacy of Fibrin Sealant Patches in Reducing the Incidence of Lymphatic Morbidity After Radical Lymphadenectomy: A Meta-Analysis. Int J Gynecol Cancer 2017; 27:1283-92. [PMID: 28640177 DOI: 10.1097/IGC.0000000000001051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although pivotal in the oncological management of most tumors, radical lymphadenectomy is associated with a significant number of lymphatic complications. The aim of this meta-analysis is to evaluate the efficacy of fibrinogen sealant patches in reducing lymphadenectomy-related postoperative complications. METHODS/MATERIALS The electronic databases PubMed, Medline, and Scopus were searched using the terms "lymphadenectomy" or "lymph node dissection" and "TachoSil," "TachoComb," or "fibrin sealant patch." Series evaluating the efficacy of fibrin-thrombin collagen sealant patches were included in the meta-analysis. RESULTS Overall, 26 studies were retrieved through the literature search. Ten studies including 720 patients met selection criteria. The use of fibrin-thrombin sealant patches to the sole scope of reducing lymphadenectomy-related complications significantly reduced the incidence of lymphocele, symptomatic lymphocele, the need of percutaneous drainage procedures, the volume of lymph drained, and the duration of the drainage. No effect on wound and/or lymphocele infection was noted. CONCLUSIONS This meta-analysis demonstrates that the use of fibrin-thrombin sealant patches significantly reduces the total volume of lymph drained, the duration of the drainage, the incidence of lymphocele and symptomatic lymphocele, and the need for postoperative percutaneous drainage procedures. Its use does not affect the incidence of wound or lymphocele infections.
Collapse
|
13
|
Conversano A, Mazouni C, Thomin A, Gaudin A, Fournier M, Rimareix F, Bonastre J. Use of Low-Thrombin Fibrin Sealant Glue After Axillary Lymphadenectomy for Breast Cancer to Reduce Hospital Length and Seroma. Clin Breast Cancer 2017; 17:293-7. [PMID: 28161131 DOI: 10.1016/j.clbc.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Axillary lymphadenectomy for primary breast cancer produces a non-negligible rate of postoperative lymphorrhea, prolonged hospital stays, and multiple seroma punctures. We evaluated the impact of low-thrombin fibrin sealant glue on surgical wounds in patients undergoing axillary lymph node dissection for breast cancer. METHODS We conducted an observational study of 149 patients who underwent axillary lymphadenectomy for primary breast cancer between January 2014 and December 2015. Data were obtained from 2 successive prospective studies. The hospital stay length and morbidity (seromas, punctures) were compared between 2 groups: patients who had padding sutures and low-thrombin fibrin sealant glue without drainage (n = 49) and patients with drainage alone (n = 100). Hospital costs were assessed from the hospital perspective. RESULTS The mean hospital stay length was shorter in the fibrin sealant group (2.6 vs. 4.7 days; P < .001). Seroma magnitude and punctures were similar in patients treated with fibrin sealant compared with patients with drainage alone. The rate of needle aspiration for seroma was similar irrespective of whether or not a drain or fibrin sealant was used (30.6% vs. 33.0%, P = .77). CONCLUSION Low-thrombin fibrin sealant glue does not significantly reduce the amount of fluid produced in the axilla after breast surgery; however, its systematic use may help reduce hospital stays and costs.
Collapse
|
14
|
Mustonen PK, Härmä MA, Eskelinen MJ. The Effect of Fibrin Sealant Combined with Fibrinolysis Inhibitor on Reducing the Amount of Lymphatic Leakage after Axillary Evacuation in Breast Cancer. Scand J Surg 2016; 93:209-12. [PMID: 15544076 DOI: 10.1177/145749690409300307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: One third of women undergoing mastectomy with axillary evacuation for primary breast cancer suffer from postoperative seromas leading to unnecessary costs and complications such as infections and new operations. Different methods to prevent seroma formation have been tried without permanent success. The aim of this prospective randomised study was to examine the effect of fibrin sealant with fibrinolysis inhibitor firstly on the reduction of the amount of lymphatic leakage after axillary evacuation and secondly on the reduction of days with drains and postoperative seroma punctures. Methods: 40 patients with primary breast cancer were prospectively randomised to the treatment group (n = 19) getting fibrin clue combined with fibrinolysis inhibitor (aprotinin) sprayed into the axillary fossa and to the control group (n = 21). Results: There were no differences in the incidence of postoperative seromas between the groups. However, the seromas were easier to treat if fibrin clue was used. Total quantity (mean ± SD) of lymphorrhea and total number of aspirations (mean ± SD) were almost twice as high in the patients of the control group compared to those having fibrin sealant. In the treatment group seromas resolved after one or occasionally after two aspirations in 71 % of patients, while in the control group 90 % of patients needed three or more aspirations. Conclusion: Potentially, fibrin sealant combined with fibrinolysis inhibitor might be used for the treatment of post-axillary evacuation lymphorrhea and seroma.
Collapse
Affiliation(s)
- P K Mustonen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | | | | |
Collapse
|
15
|
Abstract
Purpose/aim: Modified radical mastectomy is the standard surgery for breast cancer in developing countries. However, seroma formation regarded as the most frequent postoperative complication limits the therapeutic benefit of mastectomy and axillary surgery. The purpose of this study was to evaluate the efficacy of OK-432 in reducing seroma formation after axillary dissection. METHODS This prospective cohort study included 80 patients with advanced breast cancer who underwent modified radical mastectomy. Patients were randomized into two groups, which differed with the OK-432 administration. N = 40 patients per group were treated with either OK-432 plus closed suction drainage or drainage-only. RESULT In comparison with the drainage-only group, we found that patients in the OK-432 group had a lower drainage volume (p = .030) and a shorter duration of axillary drainage (p < .01). Besides, the use of OK-432 could reduce the incidence of seroma formation (p < .01) and the volume of seroma (p = .040). There were also significant differences in reducing the chance of evacuative punctures (p = .036) and the healing time (p < .01) between control and OK-432 group. CONCLUSION OK-432 not only shortened the suction drainage duration, but also significantly reduced seroma formation as well as the needs for aspiration punctures after modified radical mastectomy.
Collapse
Affiliation(s)
- Deguang Kong
- a Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| | - Yu Liu
- b Department of Geriatrics, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| | - Zhihua Li
- a Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| | - Qiuxia Cui
- a Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| | - Kun Wang
- a Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| | - Kongming Wu
- c Department of Oncology, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , P. R. China
| | - Gaosong Wu
- a Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College , Huazhong University of Science and Technology , Wuhan , P. R. China
| |
Collapse
|
16
|
Piñero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrión J, Canteras-Jordana M. Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol 2016; 114:423-7. [PMID: 27338717 DOI: 10.1002/jso.24344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy. METHODS A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed. RESULTS Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060]). CONCLUSIONS Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Antonio Piñero-Madrona
- Department of General Surgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | | | | | | |
Collapse
|
17
|
Chéreau E, Uzan C, Boutmy-Deslandes E, Zohar S, Bézu C, Mazouni C, Garbay JR, Daraï E, Rouzier R. Evaluation of the Effects of Pasireotide LAR Administration on Lymphocele Prevention after Axillary Node Dissection for Breast Cancer: Results of a Randomized Non-Comparative Phase 2 Study. PLoS One 2016; 11:e0156096. [PMID: 27280398 DOI: 10.1371/journal.pone.0156096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/01/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the efficacy (response rate centered on 80%) of a somatostatin analog with high affinity for 4 somatostatin receptors in reducing the postoperative incidence of symptomatic lymphocele formation following total mastectomy with axillary lymph node dissection. SETTING This prospective, double-blind, randomised, placebo-controlled, phase 2 trial was conducted in two secondary care centres. PARTICIPANTS All female patients for whom mastectomy and axillary lymph node dissection were indicated were eligible for the study, including patients who had received neo-adjuvant chemotherapy. Main exclusion criteria were related to diabetes, cardiac insufficiency, disorder of cardiac conduction or hepatic failure. INTERVENTIONS Patients were randomised to receive one injection of either prolonged-release pasireotide 60 mg or placebo (physiological serum), which were administered intramuscularly 7 to 10 days before the scheduled surgery. The study was conducted in a double-blind manner. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the percentage of patients who did not develop post-operative axillary symptomatic lymphoceles during the 2 postoperative months. Secondary endpoints were the total quantity of lymph drained, duration and daily volume of drainage and aspirated volumes of lymph. RESULTS Ninety-one patients were randomised. Ninety patients were evaluable: 42 patients received pasireotide, and 48 patients received placebo. The mean estimated response rate were 62.4% (95% Credibility Interval [CrI]: 48.6%-75.3%) in the treatment group and 50.2% (95% CrI: 37.6%-62.8%) in the placebo group. Overall safety was comparable across groups, and one serious adverse event occurred. In the treatment group, one patient with known insulin-depe*ndent diabetes required hospitalization for hyperglycaemia. CONCLUSIONS With this phase 2 preliminary study, even if our results indicate a trend towards a reduction in symptomatic lymphocele, pre-operative injection of pasireotide failed to achieve a response rate centered on 80%. Pharmacokinetics analysis suggests that effect of pasireotide could be optimised. TRIAL REGISTRATION ClinicalTrials.gov NCT01356862.
Collapse
|
18
|
Huang J, Yu Y, Wei C, Qin Q, Mo Q, Yang W. Harmonic Scalpel versus Electrocautery Dissection in Modified Radical Mastectomy for Breast Cancer: A Meta-Analysis. PLoS One 2015; 10:e0142271. [PMID: 26544716 PMCID: PMC4636213 DOI: 10.1371/journal.pone.0142271] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the common use of conventional electrocautery in modified radical mastectomy for breast cancer, the harmonic scalpel is recently emerging as a dominant surgical instrument for dissection and haemostasis, which is thought to reduce the morbidity, such as seroma and blood loss. But the results of published trials are inconsistent. So we made the meta-analysis to assess the intraoperative and postoperative endpoints among women undergoing modified radical mastectomy with harmonic scalpel or electrocautery. METHODS A comprehensive literature search of case-control studies from PubMed, MEDLINE, EMBASE and Cochrane Library databases involving modified radical mastectomy with harmonic scalpel or electrocautery was performed. We carried out a meta-analysis of primary endpoints including postoperative drainage, seroma development, intraoperative blood loss and secondly endpoints including operative time and wound complications. We used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the effect size for categorical outcomes and standardised mean differences (SMDs) for continuous outcomes. RESULTS A total of 11 studies with 702 patients were included for this meta-analysis. There was significant difference in total postoperative drainage (SMD: -0.74 [95%CI: -1.31, -0.16]; P< 0.01), seroma development[OR: 0.49 (0.34, 0.70); P < 0.01], intraoperative blood loss(SMD: -1.14 [95%CI: -1.81,-0.47]; P < 0.01) and wound complications [OR: 0.38 (0.24, 0.59); P < 0.01] between harmonic scalpel dissection and standard electrocautery in modified radical mastectomy for breast cancer. No difference was found as for operative time between harmonic scalpel dissection and standard electrocautery (SMD: 0.04 [95%CI: -0.41, 0.50]; P = 0.85). CONCLUSION Compared to standard electrocautery, harmonic scalpel dissection presents significant advantages in decreasing postoperative drainage, seroma development, intraoperative blood loss and wound complications in modified radical mastectomy for breast cancer, without increasing operative time. Harmonic scalpel can be recommended as a preferential surgical instrument in modified radical mastectomy.
Collapse
Affiliation(s)
- Jinbo Huang
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yinghua Yu
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Changyuan Wei
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Qinghong Qin
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Qinguo Mo
- The Department of Breast Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Weiping Yang
- The Department of Ultrasound Diagnosis, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
- * E-mail:
| |
Collapse
|
19
|
Panhofer P, Rothe S, Schütz M, Grohmann-izay B, Dubsky P, Jakesz R, Gnant M, Fitzal F. Morbidity reduction using the vessel sealing device LigaSure™ in breast cancer surgery. Eur Surg 2015; 47:150-6. [DOI: 10.1007/s10353-015-0334-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Mazouni C, Mesnard C, Cloutier AS, Amabile MI, Bentivegna E, Garbay JR, Sarfati B, Leymarie N, Kolb F, Rimareix F. Quilting Sutures Reduces Seroma in Mastectomy. Clin Breast Cancer 2015; 15:289-93. [PMID: 25661806 DOI: 10.1016/j.clbc.2014.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drainage duration and seroma formation occurring after mastectomy with or without axillary surgery lengthens hospitalization and delays adjuvant treatment. The aim of the study was to evaluate the effect of quilting in the prevention of seroma after mastectomy for breast cancer. PATIENTS AND METHODS Eighty-two breast cancer patients about to undergo mastectomy with or without axillary surgery lymphadenectomy were enrolled in the study. We conducted an observational comparison between 41 patients in whom quilting with closed suction drainage was used and 41 patients in whom drainage only was used. RESULTS The mean drained volume was significantly lower in the quilting group compared with the control group on days 1 and 2 (day 1: 107.1 mL vs. 156.5 mL; P = .02; day 2: 108.4 mL vs. 162.8 mL; P = .01). The mean drainage period was shorter in the quilting group (4.6 vs. 5.3 days; P = .046). There were fewer needle aspirations for seroma in the padding group (n = 14, 34.1% vs. n = 24, 58.5%; P = .03). CONCLUSION The use of padding after mastectomy seems to reduce seroma formation, volume drained, and length of drainage time.
Collapse
Affiliation(s)
- Chafika Mazouni
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France.
| | - Chrystelle Mesnard
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Alexis-Simon Cloutier
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Maria-Ida Amabile
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Enrica Bentivegna
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Benjamin Sarfati
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Nicolas Leymarie
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Frédéric Kolb
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Françoise Rimareix
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| |
Collapse
|
21
|
Yeniay L, Ünalp Ö, Uğuz A, Ünver M, Karaca A, Sezer T, Yoldaş T, Demir H, Zekioğlu O, Kapkaç M, Yilmaz R. Can polyglactin mesh be used for prevention of seroma after mastectomy: an experimental study. Eur Surg 2014. [DOI: 10.1007/s10353-014-0281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
22
|
|
23
|
He S, Song T, Xie L, Fu L, Huang Z, Lin T. Stilamin in the Treatment of Lymphatic Leaks After Living-Related Renal Transplantation. Transplant Proc 2013; 45:3302-4. [DOI: 10.1016/j.transproceed.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/10/2013] [Accepted: 04/23/2013] [Indexed: 11/16/2022]
|
24
|
Ramirez-Hernandez IE, Hardman RL, Kirkpatrick AD, Sutcliffe J. Post-operative seroma causing spontaneous nipple discharge: diagnosis by galactography. J Radiol Case Rep 2013; 7:16-22. [PMID: 23705053 DOI: 10.3941/jrcr.v7i5.1229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nipple discharge is a common breast complaint in women. Discharge in the post-operative patient for breast cancer is especially concerning, as these women are at higher risk for recurrent or new breast cancer. Galactography is a reliable method to evaluate nipple discharge, attempting to identify a mass that may cause the discharge within the duct of concern. We present two cases of women with spontaneous nipple discharge after lumpectomy for breast cancer. In both cases, evaluation with galactography demonstrated a post-operative seroma that communicated with a native breast duct, causing nipple discharge. This presentation of a post-operative seroma is important to recognize by breast surgeons and breast imagers. Galactography can play an important role in the work up of these patients, demonstrating etiology of the nipple discharge with greater confidence than other imaging modalities.
Collapse
|
25
|
Tauber R, Schmid S, Horn T, Thalgott M, Heck M, Haller B, Kübler H, Autenrieth M, Retz M, Gschwend JE, Maurer T. Inguinal lymph node dissection: Epidermal vacuum therapy for prevention of wound complications. J Plast Reconstr Aesthet Surg 2013; 66:390-6. [DOI: 10.1016/j.bjps.2012.09.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/26/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
|
26
|
Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 2012; 15:373-80. [PMID: 23346164 PMCID: PMC3542843 DOI: 10.4048/jbc.2012.15.4.373] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022] Open
Abstract
Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Seroma has been defined as serous fluid collection under the skin flaps or in the axillary dead space following mastectomy and/or axillary dissection. Because the true etiology of a seroma is unknown, a multifactorial-causation hypothesis has been accepted. Surgical factors include technique, extent of dissection and the surgical devices used for dissection. Obliteration of dead space with various flap fixation techniques, use of sclerosants, fibrin glue and sealants, octreotide, and pressure garments have been attempted with conflicting results and none have been consistent. Early movement of the shoulder during the postoperative period may increase the formation of seroma, although delayed physiotherapy decreases the formation of seroma. A detailed analysis of the use of drains showed that use of single or multiple drains, early or late removal, and drains with or without suction are not significantly different for the incidence of seroma. Although there is evidence for reduced seroma formation after early drain removal, very early removal within 24 hours seems to increase formation of seroma. No patient or tumor factors seem to affect seroma formation except body mass index and body weight. Consensus is lacking among studies/trials with different groups producing conflicting evidence. Besides a few established factors such as body mass index, the use of electrocautery for dissection, early drain removal, low vacuum drains, obliteration of dead space, and delayed shoulder physiotherapy, most of the hypothesized causes have not been demonstrated consistently. Thus, seroma remains a threat to both the patient and surgeon. Recurrent transcutaneous aspiration remains the only successful management.
Collapse
Affiliation(s)
- Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | | |
Collapse
|
27
|
Zárate Moreno FA, Oms Bernad LM, Mato Ruiz R, Balaguer del Ojo C, Sala Pedrós J, Campillo Alonso F. [Efficacy of octreotide in the treatment of chyle fistulas associated with pancreatic disease]. Cir Esp 2012; 91:237-42. [PMID: 23228417 DOI: 10.1016/j.ciresp.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 09/13/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A chyle fistula is an uncommon complication following abdominal and pancreatic surgery, particularly in the retroperitoneal compartment. It can also appear as a complication of a severe acute pancreatitis. Medical treatment is the initial approach, but resolution is often slow. Somatostatin or octreotide can help in accelerating the resolution of fistulae. PATIENTS AND METHODS Patients developing a chyle fistula (output > 100ml/24h, normal amylase levels and triglyceride concentrations above 110mg/dl) associated with pancreatic disorders were treated with oral intake restriction and parenteral nutrition, followed by subcutaneous octreotide 0.1mg/8h. RESULTS Four female patients from 55 to 80 years old, underwent pancreatic surgery or presented with an acute pancreatitis, were treated. Chyle fistulae ranging from 100 to 2,000ml/24h were treated with octreotide, being resolved within five to seven days. No recurrence has been found in a 2 to 4 years follow up. CONCLUSIONS We have found that chyle fistula medical treatment is often related to a slow resolution, somatostatin or octreotide administration dramatically reduces its duration. Other previously reported studies have also shown that the quick onset of such treatment can accelerate the whole process, leading to a shorter recovery and lower hospital costs.
Collapse
Affiliation(s)
- Fabián A Zárate Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Consorci Sanitari de Terrassa, Tarrasa, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
28
|
Lemaitre J, Segers B, Lebrun E. The use of lanreotide in the management of lymphorrhea after an aortic valve replacement. Interact Cardiovasc Thorac Surg 2012; 15:762-3. [PMID: 22753432 DOI: 10.1093/icvts/ivs243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lymphorrhea is a rare but potentially serious complication following various surgical procedures. Uncontrolled lymph drainage may lead to infection and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually involves bed rest, drainage and pressure dressings. These methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from the groin wound after an aortic valve replacement. The patient presented with significant lymph drainage from the postoperative inguinal wound. Lymphorrhea was successfully treated with a long-acting somatostatin analogue, lanreotide. No recurrence was observed after 1 and 6 months of patient follow-up. This case report demonstrates the successful use of lanreotide in the control of lymphorrhea following groin dissection for vascular access.
Collapse
Affiliation(s)
- Jean Lemaitre
- Service de Chirurgie Viscérale et Vasculaire, CHU Ambroise Paré, Mons, Belgium.
| | | | | |
Collapse
|
29
|
Gauthier T, Garuchet-Bigot A, Marin B, Mollard J, Loum O, Fermeaux V, Jammet I, Kanoun D, Maubon A, Aubard Y. Lanreotide Autogel 90 mg and lymphorrhea prevention after axillary node dissection in breast cancer: a phase III double blind, randomized, placebo-controlled trial. Eur J Surg Oncol 2012; 38:902-9. [PMID: 22703757 DOI: 10.1016/j.ejso.2012.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/16/2012] [Accepted: 05/21/2012] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of this study was to assess the efficacy of Lanreotide Autogel 90 mg PR to prevent lymphorrhea after axillary dissection in breast cancer. METHODS A Phase III double-blind, randomized, placebo-controlled trial was performed between April 1st, 2008, and December 31st, 2010. The primary endpoint was the lymphorrhea volume (ml) in the axillary drain during the first four postoperative days. The secondary end points were the number of days until axillary drain removal, hospital stay duration (days), lymphorrhea volume (ml) up to days 15, 30 and 180, number of cases with seroma aspiration and number of seroma aspirations, evaluation of wound, arm pain and mobility on days 15, 30 and 180. RESULTS A total of 148 patients were recruited for the study. Altogether 145 patients were randomized and analysed on an intention-to-treat basis. On the day before surgery 73 patients received the placebo and 72 patients received lanreotide. At four postoperative days, there was a tendency towards a reduction of the lymphorrhea volume in the lanreotide group (median 292 ml, range 1-965 ml) as compared to the placebo group (median 337 ml, range 0-1230 ml), although it was not statistically significant (p = 0.18). There was no significant difference for the secondary end points. In the group with axillary dissection performed alone (n = 24), the lymphorrhea volume was shown to be significantly reduced in the lanreotide group, (p = 0.035) as compared to the placebo group. CONCLUSION Our study did not identify any overall significant reduction of lymphorrhea on lanreotide.
Collapse
|
30
|
McNeely ML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW. A prospective model of care for breast cancer rehabilitation: postoperative and postreconstructive issues. Cancer 2012; 118:2226-36. [PMID: 22488697 DOI: 10.1002/cncr.27468] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Appropriate and timely rehabilitation is vital in the recovery from breast cancer surgeries, including breast conserving surgery, mastectomy, axillary lymph node dissection (ALND), and breast reconstruction. This article describes the incidence, prevalence, risk factors and time course for early postoperative effects and the role of prospective surveillance as a rehabilitation strategy to prevent and mitigate them. The most common early postoperative effects include wound issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and seroma. Appropriate treatment is necessary to avoid delay in wound healing that may increase the risk of long-term morbidity, unduly postpone systemic and radiation therapy, and delay rehabilitation. The presence of upper quarter dysfunction (UQD), defined as restricted upper quarter mobility, pain, lymphedema, and impaired sensation and strength, has been reported in over half of survivors after treatment for breast cancer. Moreover, evidence suggests that survivors who undergo breast reconstruction may be at higher risk of UQD. Ensuring the survivor's optimum functioning in the early postoperative time period is critical in the overall recovery from breast cancer. The formal collection of objective measures along with patient-reported outcome measures is recommended for the early detection of postoperative morbidity. Prospective surveillance, including preoperative assessment and structured surveillance, allows for early identification and timely rehabilitation. Early evidence supports a prospective approach to address and minimize postoperative effects.
Collapse
Affiliation(s)
- Margaret L McNeely
- Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada.
| | | | | | | | | | | |
Collapse
|
31
|
Achouri A, Huchon C, Bats AS, Bensaïd C, Nos C, Lécuru F. Postoperative lymphocysts after lymphadenectomy for gynaecological malignancies: preventive techniques and prospects. Eur J Obstet Gynecol Reprod Biol 2012; 161:125-9. [DOI: 10.1016/j.ejogrb.2011.12.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/15/2011] [Accepted: 12/20/2011] [Indexed: 11/24/2022]
|
32
|
Gauthier T, Gouy S, Uzan C, Kane A, Morice P. [Prevention of lymphoceles and gynaecologic cancers]. Gynecol Obstet Fertil 2011; 39:698-703. [PMID: 22104967 DOI: 10.1016/j.gyobfe.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 09/20/2011] [Indexed: 02/06/2023]
Abstract
Lymphoceles are the most frequent complications following systematic lymphadenectomy in gynaecologic cancers. Some of them may have clinical significance with high morbidity. Through a review of literature, we describe surgical methods (way of surgery, lymphadenectomy type, sentinel lymph node, peritonization, drainages, lymphostasis, surgical patch) and medical methods (somatostatin analogs and nutrition treatment) which could prevent lymphoceles formation after pelvic and lumboaortic lymphadenectomy.
Collapse
|
33
|
van Bemmel A, van de Velde C, Schmitz R, Liefers G. Prevention of seroma formation after axillary dissection in breast cancer: A systematic review. Eur J Surg Oncol 2011; 37:829-35. [DOI: 10.1016/j.ejso.2011.04.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 04/03/2011] [Accepted: 04/25/2011] [Indexed: 10/17/2022] Open
|
34
|
Sampathraju S, Rodrigues G. Seroma formation after mastectomy: pathogenesis and prevention. Indian J Surg Oncol 2011; 1:328-33. [PMID: 22693384 DOI: 10.1007/s13193-011-0067-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022] Open
Abstract
Post mastectomy seroma remains an unresolved quandary as the risk factors for its formation have still not been identified. Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. Various techniques and their modifications have been practiced and published in English literature, but there seems to be no consensus. In this article, all aspects of seroma formation from pathogenesis to prevention including drug therapies have been discussed.
Collapse
Affiliation(s)
- Sanjitha Sampathraju
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, 576 104 Karnataka India
| | | |
Collapse
|
35
|
Capitanio U, Pellucchi F, Gallina A, Briganti A, Suardi N, Salonia A, Abdollah F, Di Trapani E, Jeldres C, Cestari A, Karakiewicz PI, Montorsi F. How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical implications. BJU Int 2010; 107:1095-101. [PMID: 20880192 DOI: 10.1111/j.1464-410x.2010.09580.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To identify clinical and pathological variables that may help clinicians in predicting, preventing and managing lymphorrhoea and clinically significant lymphocoeles (CSL), which are reported complications after pelvic lymphadenectomy (PLND) and retropubic radical prostatectomy (RRP). PATIENTS AND METHODS • We prospectively analysed 552 consecutive men with prostate cancer who underwent RRP and PLND (2006-2008). • All patients had detailed clinical and pathological data prospectively recorded in an electronic database. Drains were removed when the amount of lymph was < 20 mL in the previous 24 h. A CSL was defined as the presence of a symptomatic lymphocoele requiring treatment. Lymphorrhoea was defined as the total amount of lymph drained by the drains until their removal. • Univariable and multivariable logistic regression models were used to test the association between all the predictors (age, body mass index, American Society of Anesthesiologists score, prostate volume, clinical stage, number of LNs removed, surgeon, pathological T and N stage) and the presence of CSL. • Univariable and multivariable linear regression models were also used to test the association between the available predictors and lymphorrhoea. RESULTS • The median (range) number of LNs removed was 20 (1-63). Both linear and logistic multivariable regression analysis showed that the number of removed LNs and age were the only two statistically significant predictors of total amount of lymphorrhoea and CSL after RRP and PLND (both P < 0.01). • Specifically, the risk of developing a CSL increased by 5% for every LN removed. Similarly, every year of age increased the risk of having CSL by 5%. • The most informative thresholds for predicting CSL were 65 years of age and 20 LNs removed. • External iliac lymphadenectomy resulted in a higher associated risk of lymphorrhoea and CLS relative to obturator LN removal (P= 0.001 vs P= 0.1, respectively). CONCLUSIONS • There was a positive association between the number of LNs removed and age at RRP with the amount of lymphorrhoea and the risk of developing a CSL. • The most informative thresholds in predicting CSL were 65 years of age and 20 LNs removed. External iliac lymphadenectomy resulted in a higher risk of lymphorrhoea and CLS relative to obturator LN removal.
Collapse
Affiliation(s)
- Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Hospital, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kim WT, Ham WS, Koo KC, Choi YD. Efficacy of Octreotide for Management of Lymphorrhea After Pelvic Lymph Node Dissection in Radical Prostatectomy. Urology 2010; 76:398-401. [DOI: 10.1016/j.urology.2009.04.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 04/22/2009] [Accepted: 04/29/2009] [Indexed: 11/17/2022]
|
37
|
Abstract
The occurrence of edema is a serious problem of patients suffering from cancer and may have various causes. Particularly, the secondary malignant lymphedema poses a special threat to patients. In some cases, it indicates the progression of illness, and in fact also results in mutilating physical changes, which add to the already existing impairments caused by the cancer disease. So far therapeutic interventions are limited. Current management consists of physical therapy and pharmacological interventions. There are few powerful studies concerning the efficiency and hardly any concerning combined or comparative treatment in the literature. Most of them focus on the management of lymphedema in breast cancer patients. Preventive measures and supportive therapy are rarely being discussed. In this case report, we describe the successful use of Selen and Sandostatin in treating a facial edema of a patient with advanced head-neck cancer.
Collapse
Affiliation(s)
- Bernhard Hammerl
- Station für Palliativmedizin, 5. Medizinische Abteilung mit Onkologie, Krankenhaus Hietzing, Wien, Osterreich.
| | | |
Collapse
|
38
|
Zawaneh PN, Putnam D. Materials in Surgery: A Review of Biomaterials in Postsurgical Tissue Adhesion and Seroma Prevention. Tissue Engineering Part B: Reviews 2008; 14:377-91. [DOI: 10.1089/ten.teb.2008.0226] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Peter N. Zawaneh
- School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York
| | - David Putnam
- School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York
- Department of Biomedical Engineering, Cornell University, Ithaca, New York
| |
Collapse
|
39
|
Kapella M, Gana J, Decroisette E, Aubard Y. Para-aortic lymphocele treated with an injection of somatostatine analog (lanreotide). Eur J Obstet Gynecol Reprod Biol 2008; 141:89-90. [DOI: 10.1016/j.ejogrb.2008.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 05/05/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
|
40
|
Sheng-Zhang L, Hong-Fei T, Zhong-Lin N, Yao-Jun Y, Tao Y, Wei Z. Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer. J Cancer Res Clin Oncol 2009; 135:613-6. [PMID: 18846385 DOI: 10.1007/s00432-008-0495-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 09/21/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Lymphorrhea is an uncommon complication of abdominal surgery. Here, we retrospectively investigate the treatment and prevention of lymphorrhea after radical gastrectomy. METHODS From January 1995 to January 2007, a total of 1,596 patients who underwent surgery for gastric cancer were investigated. According to the AJCC cancer stage manual, tumor stages of 693 (43.4%) cases were T1 or T2 and 903 (56.6%) cases were T3 or T4. A total of 1,104 (69.2%) patients received grade D1 lymphadenectomy or grade D2, and 492 (30.8%) patients received grade D3 or D4. Ligation was used during the lymphadenectomy in 829 (51.9%) patients, and the electrotome cautery was used in 767 (48.1%) patients. Patients diagnosed of lymphorrhea were treated with total parenteral nutrition (TPN) alone before 2001, and with TPN plus octreotide after 2001. RESULTS The incidence of lymphorrhea of patients with D1-2 lymphadenectomy was much lower than those with D3-4 lymphadenectomy (P < 0.01). For patients whose lymphatic vessels were ligated during the operation, the incidence of lymphorrhea was much lower than those lymphatic vessels were electrically cauterized (P < 0.01). No significant difference of incidence of lymphorrhea could be found between patients with T1-2 and T3-4 tumor stages (P > 0.05). Octreotide or TPN administration can reduce the quantity and duration of lymphorrhea,and the combination of Octreotide and TPN has a more significant effect on lymphorrhea than TPN alone (P < 0.01). CONCLUSION The major cause of lymphorrhea following radical gastrectomy was the inappropriate management of lymphadenectomy. Avoiding an extensive lymphadenectomy at surgery and ligating the disrupted lymph vessels would reduce the incidence of lymphorrhea. The combination of Octreotide and TPN is an effective therapeutic modality for lymphorrhea.
Collapse
|
41
|
Prommer EE. Established and potential therapeutic applications of octreotide in palliative care. Support Care Cancer 2008; 16:1117-23. [PMID: 18256859 DOI: 10.1007/s00520-007-0399-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 12/19/2007] [Indexed: 11/29/2022]
Abstract
Octreotide acetate was developed as a pharmacologically stable, long-acting analogue of the hormone somatostatin. Mimicking the actions of somatostatin, octreotide has been used for its antisecretory effects. Randomized control trials have established the efficacy of octreotide for malignant bowel obstruction and for chemotherapy-induced diarrhea. Octreotide has proven to be an effective agent for symptoms of carcinoid syndrome. Newer uses include for bone marrow transplantation, infectious diarrheal syndromes, and management of hepatic metastases. More evidence is needed for the establishment of its efficacy for hypercalcemia, pain, pleural effusions, diarrhea after celiac plexus block, and malignant ascites.
Collapse
Affiliation(s)
- Eric E Prommer
- Division of Hematology/Oncology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| |
Collapse
|
42
|
Antonio M, Pietra T, Domenico L, Massimo D, Ignazio R, Antonio N, Luigi C. Does LigaSure reduce fluid drainage in axillary dissection? A randomized prospective clinical trial. Ecancermedicalscience 2007; 1:61. [PMID: 22275958 PMCID: PMC3223974 DOI: 10.3332/ecms.2007.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Indexed: 11/29/2022] Open
Abstract
Background: Axillary lymph node dissection (ALND) is an integral part of breast cancer treatment. It is required in about 40–50% of patients. The placement of a drain in the axilla after an operation is current surgical practice. Short surgical stay programmes increase operating efficiency and reduce medical care costs, without compromising quality of care. LigaSure™ is a new haemostatic device that uses bipolar energy to seal vessels. The aim of this study is to determine whether axillary dissection with LigaSure™ reduces the time of wound drainage, the duration of surgical intervention and the volume of drainage after treatment. Patients and methods: This study is a prospective randomized controlled trial. A total of 100 women with breast cancer who needed axillary dissection were randomized into the LigaSure™ or conventional axillary dissection group. Levels I to III lymph node dissection was performed. A closed suction drain was always placed in the axilla and removed after 6–8 days or when fluid amount was <60 cc in the previous 24 hours. Results: There were no significant differences between the two groups when considering the duration of surgical procedure: average duration was 70.7 ± 24.66 minutes for LigaSure™ patients, while in the conventional dissection group the mean was 70.6 ± 22.47 minutes (p=0.98). Total amount of drained fluid was 624.49 cc in the LigaSure™ axillary dissection group and 792.96 in the conventional ALND group; this difference did not achieve statistical significance (p=0.09); the duration of draining was also similar, with no statistical difference (p=0.15). Conclusions: The present study did not show clear advantages in LigaSure™ use for ALND, although it represents a good haemostatic device, especially in abdominal surgery.
Collapse
Affiliation(s)
- M Antonio
- Department of Experimental Oncology and Clinical Application, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined. METHOD MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out. RESULT The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive. CONCLUSION Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.
Collapse
Affiliation(s)
- Amit Agrawal
- Professorial Unit of Surgery, Nottingham City Hospital, Nottingham, UK
| | | | | |
Collapse
|
44
|
Abstract
Most breast operations are categorized as low-morbidity procedures, but a variety of complications can occur in association with diagnostic and multidisciplinary management procedures. Some of these complications are related to the breast itself, and others are associated with axillary staging procedures. This article first addresses some general, nonspecific complications (wound infections, seroma formation, hematoma). It then discusses complications that are specific to particular breast-related procedures: lumpectomy (including both diagnostic open biopsy and breast-conservation therapy for cancer), mastectomy; axillary lymph node dissection, lymphatic mapping/sentinel lymph node biopsy, and reconstruction.
Collapse
Affiliation(s)
- Angelique F Vitug
- University of Michigan, Breast Care Center, 1500 East Medical Center Drive, 3308 CGC, Ann Arbor, MI 48167, USA
| | | |
Collapse
|
45
|
|
46
|
Capocasale E, Busi N, Valle RD, Mazzoni MP, Bignardi L, Maggiore U, Buzio C, Sianesi M. Octreotide in the Treatment of Lymphorrhea After Renal Transplantation: A Preliminary Experience. Transplant Proc 2006; 38:1047-8. [PMID: 16757259 DOI: 10.1016/j.transproceed.2006.03.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation. MATERIALS AND METHODS This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. RESULTS The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted. CONCLUSION The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.
Collapse
Affiliation(s)
- E Capocasale
- General Surgery and Organ Transplantation, University of Parma, Italy
| | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Pepper MS. Literature watch. FOXC2 haploinsufficient mice are a model for human autosomal dominant lymphedema-distichiasis syndrome. Lymphat Res Biol 2004; 1:245-9. [PMID: 15624441 DOI: 10.1089/153968503768330274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S Pepper
- Department of Morphology, University of Geneva Medical Center, Switzerland
| |
Collapse
|
49
|
Scientific Surgery. Br J Surg 2003; 90:1310-1310. [DOI: 10.1002/bjs.4384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|