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Axillary lymphadenectomy for breast cancer without axillary drainage
S S Jeffrey1, W H Goodson, D M Ikeda
1Department of Surgery, Stanford University School of Medicine, Calif, USA.
Objective:
To evaluate axillary lymph node dissection done without closed drainage in conjunction with breast conservation cancer surgery.
Design:
Prospective clinical study.
Setting:
Two university hospitals.
Patients:
Eighty-one women undergoing wide local excision of breast cancer with simultaneous or subsequent axillary lymph node dissection.
Interventions:
No axillary drain was placed following axillary lymphadenectomy.
Main Outcome Measures:
The development and resorption of axillary seroma fluid as measured by clinical aspiration and serial sonographic examination.
Results:
Thirty-four (42%) of the 81 women required axillary seroma aspiration even though axillary fluid was present in 92% (22/24) of those studied sonographically. The seromas accumulated over the first 2 weeks following axillary dissection and resorbed over the next 2 weeks, as assessed by both clinical and sonographic examination. The complication rate was 2% (2/81). The surgery was performed safely on an outpatient or short-stay basis in 99% (80/81) of patients. All patients except one were discharged within 23 hours of surgery, and 56 patients were discharged directly after anesthesia.
Conclusion:
Axillary lymph node dissection done in conjunction with breast conservation surgery can be performed in an ambulatory or short-stay setting without axillary drainage. Postoperative seromas will resolve within 1 month, and fewer than half will require aspiration. Lymphadenectomy without drainage reduces morbidity and allows the patient greater personal comfort.