Whether drainage should be used after surgery for breast cancer? A systematic review of randomized controlled trials

A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether patients benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer surgery. RCTs of drainage versus no drainage after ALND in women with breast cancer were retrieved from PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors independently assessed the quality of included trials and extracted data. Odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were presented with 95% confidence intervals (CI). A total of 1115 titles were indentified from the databases; 1109 obvious irrelevant studies were excluded by examining the titles, abstracts, full texts because of duplicates, no RCT, different modality of drainage, drain for lymphedema, application of fibrin sealant and so on. And then, only 6 RCTs to compare drainage with no drainage after ALND in breast cancer surgery were included in the systematic review and a total of 585 patients were included in the pathological diagnosis of breast cancer in women before surgery, management by ALND with or without addition surgical procedures. The study demonstrated that insertion of a drain in the axilla after breast cancer surgery resulted in a statistically significant reduction in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P < 0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There was no statistically significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25) between drainage group and no drainage group. Based on the current evidence, insertion of a drain in the axilla following ALND in breast cancer surgery effectively decreased seroma formation, volume of aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound infection, but extending their stay in hospital.