Abstract
Background
Women undergoing surgery for primary breast cancer routinely have suction drains inserted deep to the wounds. A lack of data exists in relating how long suction drains should stay in situ after major breast surgery.
Purpose
This study evaluates the appropriate timing of drain removal by comparing the 5-day-long postoperative drainage or drain removal when less than 50 mL/24 h to conventional drain removal.
Methods
This controlled clinical trial was undertaken between February 1997 and May 2012 with a total of 214 consecutive patients who underwent elective total or partial mastectomy with level II axillary lymph node dissection. The main outcome measures included the length of hospital stay, and surgical morbidity, especially seroma formation.
Results
In the study group, the age and operation time were significantly increased compared to the conventional group whereas the median hospital stay was significantly shorter in the study group than the control group (7 days vs. 9 days; p < 0.05). The incidence of seroma was 42.8 % in the study group and 31.6 % in the control group (p = 0.14). The mean number of outpatient visits for seroma was 3.6 in the study group and 1.5 in the control group (p < 0.05). Drainage volume of more than 150 mL/24 h all resulted in seroma formation.
Conclusions
The new criteria for early drain removal are safe and acceptable despite the slightly increased chance of seroma formation.
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References
Droeser RA, Frey DM, Oertli D, Kopelman D, Baas-Vrancken Peeters MJ, Giuliano AE, Dalberg K, Kallam R, Nordmann A. Volume-controlled vs no/short-term drainage after axillary lymph node dissection in breast cancer surgery: a meta-analysis. Breast. 2009;18:109–14.
Yii M, Orr N, Murphy C. Early removal of drains and discharge of breast cancer surgery patients: a controlled prospective clinical trial. Ann R Coll Surg Engl. 1995;77:377–9.
Purushotham AD, McLatchie E, Young D, George WD, Stallard S, Doughty J. Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg. 2002;89:286–92.
Talbot ML, Magarey CJ. Reduced use of drains following axillary lymphadenectomy for breaset cancer. ANZ J Surg. 2002;72:488–90.
He X-D, Guo Z-H, Tian J-H, Yang K-H, Xie X-D. Whether drainage should be used after surgery for breast cancer? A systematic review of randomaized controlled trials. Med Oncol. 2011;28:S22–30.
Kopelman D, Klemm O, Bahous H, Klein R, Krausz M, Hashmonai M. Postoperative suction drainage of the axilla: for how long? Prospective Randomised Trial. Eur J Surg. 1999;165:117–20.
Barton A, Blitz M, Callahan D, Yakimets W, Adams D, Dabbs K. Early removal of postmastectomy drains is not beneficial: results from a halted randomized controlled trail. Am J Surg. 2006;191:652–6.
Gupta R, Patel K, Varshney S, Goddard J, Royle GT. A comparison of 5-day and 8-day drainage following mastectomy and axillary clearance. EJSO. 2001;27:26–30.
Tadych K, Donegan WL. Postmastectomy seromas and wound drainage. Surg Gynecol Obstet. 1987;165:483–7.
Bryant M, Baum M. Postoperative seroma following mastectomy and axillary dissection. Br J Surg. 1987;58:239–42.
Amit A, et al. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76:1088–95.
Aitken D, Minton J. Complications associated with mastectomy. Surg Clin North Am. 1983;63:1331–5.
Chilson TR, Chan FD, Lonser RR, Wu TM, Aitken DR. Seroma prevention after modified radical mastectomy. Am Surg. 1992;58:750–4.
Jeffry SS, Goodson WH, Ikeda DM, Birdwell RL, Bogetz MS. Axillary lymphadenectomy for breast cancer without axillary drainage. Arch Surg. 1995;130:909–13.
Ackroyd R, Reeed MWR. A prospective randomized trial of the management of suction drains following breast cancer surgery with axillary clearance. The Breast. 1997;6:271–4.
Acknowledgments
The authors thank Drs. Hiroki Saito, Kiyotaka Imamura, Yoshihide Nanno, Mayu Shimaguchi, Minori Ishii, and Toru Shimizu for their support in this study. Also, they would like to thank the healthcare information managers and medical clerks who have helped collect patient data and Dr. Christine Kwan for her help in preparing the English manuscript.
Conflict of interest
Naoya Okada and the other co-authors have no conflict of interest.
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Okada, N., Narita, Y., Takada, M. et al. Early removal of drains and the incidence of seroma after breast surgery. Breast Cancer 22, 79–83 (2015). https://doi.org/10.1007/s12282-013-0457-3
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DOI: https://doi.org/10.1007/s12282-013-0457-3