Ultrasonic shears versus electrocautery in axillary dissection for breast cancer-a randomized controlled trial

Theoretical advantages of use of Ultrasonic shears include less tissue damage and better sealing of lymphatic vessels. This may play a role in reducing prolonged drainage following axillary dissection for breast cancer. We conducted a prospective randomized controlled study to evaluate efficacy of ultrasonic shears over cautery for axillary dissection. Between April 2011 and April 2013, 92 patients were randomized to undergo axillary dissection with either ultrasonic shears (n = 46) or electrocautery (n = 46). Primary endpoints were time till drain removal and cumulative axillary drainage. Categorical data were compared by Pearson's chi-squared test. Continuous variables were compared by Independent t test or Mann Whitney U test. Data was analyzed using SPSS version 18.0. Both groups were comparable with respect to clinical and pathologic characteristics. Clinical characteristics of mean age, body mass index, side of tumor, neoadjuvant chemotherapy, and type of surgery (breast conservation or mastectomy) were similar. Pathologic variables (weight of specimen, number of lymph nodes harvested, pathologic T and N status, as well as grade of tumor) were also comparable among the two groups. There was no statistically significant difference in either primary endpoint of time till drain removal (15 vs. 14.5 days, p = 0.73) or cumulative axillary drainage (1,260 vs. 1,086.5 ml, p = 0.79). Patient and disease characteristics among the two groups were similar. But, there was no difference in either primary endpoint of cumulative axillary drainage or time to drain removal. We conclude that there is no advantage to use of ultrasonic shears over cautery in reducing drainage following axillary dissection for breast cancer.