BACKGROUND: To reduce the risk of seroma after modified radical mastectomy in breast cancer patients, the use of suction axillary drainage is a standard procedure. The optimal time to remove the drain is not established. Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear. METHOD: The trial included 247 patients with breast cancer who underwentmodified radical mastectomyin five Swedish hospitals 1993-1997. The median follow-up time was 6 years. One hundred and twenty-two and 125 patients, respectively, were randomised between removal versus preservation of the pectoral fascia. Of these 247 patients a total of 198 patients were also randomised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h. RESULTS: Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay. There were no differences between the two groups regarding the rate of wound infections and/or hematoma formation. Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding. A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia (16/125 compared with 8/122; hazard ratio=2.0, 95% confidence interval=0.9-4.7). CONCLUSION: Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications. However, it yielded a significantly higher incidence of seroma. Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not.
RCT Entities:
BACKGROUND: To reduce the risk of seroma after modified radical mastectomy in breast cancerpatients, the use of suction axillary drainage is a standard procedure. The optimal time to remove the drain is not established. Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear. METHOD: The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993-1997. The median follow-up time was 6 years. One hundred and twenty-two and 125 patients, respectively, were randomised between removal versus preservation of the pectoral fascia. Of these 247 patients a total of 198 patients were also randomised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h. RESULTS: Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay. There were no differences between the two groups regarding the rate of wound infections and/or hematoma formation. Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding. A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia (16/125 compared with 8/122; hazard ratio=2.0, 95% confidence interval=0.9-4.7). CONCLUSION: Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications. However, it yielded a significantly higher incidence of seroma. Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not.
Authors: Janet P Edwards; Elizabeth J Kelly; Yongtao Lin; Taryn Lenders; William A Ghali; Andrew J Graham Journal: Can J Surg Date: 2012-06 Impact factor: 2.089
Authors: Ömer Uslukaya; Ahmet Türkoğlu; Metehan Gümüş; Zübeyir Bozdağ; Ahmet Yılmaz; Hatice Gümüş; Şeyhmus Kaya; Mesut Gül Journal: J Breast Health Date: 2016-07-01
Authors: Florian Ebner; Niko deGregorio; Elena Vorwerk; Wolfgang Janni; Achim Wöckel; Dominic Varga Journal: Breast Care (Basel) Date: 2014-05 Impact factor: 2.860
Authors: F Hinten; L C G van den Einden; J C M Hendriks; A G J van der Zee; J Bulten; L F A G Massuger; H P van de Nieuwenhof; J A de Hullu Journal: Br J Cancer Date: 2011-10-04 Impact factor: 7.640