Clinical surgery-International
Sealants after axillary lymph node dissection for breast cancer: good intentions but bad results

https://doi.org/10.1016/j.amjsurg.2008.06.043Get rights and content

Abstract

Background

This study was conducted to evaluate the effect of 2 surgical sealants on postsurgical drainage and lymphocele formation after axillary surgery for breast cancer.

Methods

This was a prospective, randomized study. Seventy-seven consecutive patients with breast cancer were included and randomized into a control group (18F vacuum drain) and 2 study groups (18F vacuum drain plus COSEAL or BioGlue).

Results

The 3 groups were matched. Neither postsurgical drainage nor time to drain removal was affected by the use of either of the 2 sealants. Although no statistically significant difference in lymphocele formation and wound infection was noted, complications caused by intense foreign-body reaction that led to surgical intervention occurred in both study groups.

Comments

The use of surgical sealants is not recommended after axillary lymph node dissection for breast cancer. Complications of their use may lead to reoperation.

Section snippets

Patients and Methods

A prospective, randomized study was conducted between October 2003 and November 2005 in the Breast Cancer Unit of the Department of Surgical Oncology of our hospital.

Results

Four surgeons operated on 77 consecutive patients with breast cancer. Pathologic preoperative confirmation existed for all patients. Mean patient age was 55.5 ± 12.0 (range 33 to 79). Seventy patients underwent lumpectomy plus ALND (90.9%), and 7 patients underwent ALND only (9.1%). The incidence of wound infection (primarily mild erythema) and lymphocele formation was 24.7% and 11.7%, respectively.

The 3 groups were matched for age and BMI. The majority underwent lumpectomy and ALND for stage

Comments

Compared with previous studies related to the use of sealants after axillary surgery, the results of this study are characterized by some unique properties. COSEAL and BioGlue are commercially available sealants and have been used in different settings but never after ALND for breast cancer. Previous studies have used fibrin glue, but the sealing effect needed to decrease postsurgical drainage can also be achieved by different products. We excluded patients who had undergone mastectomy (often

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