Incidence of Clinically Significant Seroma after Breast and Axillary Surgery

Boostrom, Sarah Y.; Throckmorton, Alyssa; Boughey, Judy C.; Holifield, Andrea C.; Zakaria, Shaheen; Hoskin, Tanya L.; Degnim, Amy C.

doi:10.1016/j.jamcollsurg.2008.08.029

Cited by 66 publications

(52 citation statements)

References 6 publications

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“…Also, there was significant reduction in incidence of seroma favoring the study group by incidence 6.5% (2 patients out of 31) compared to 25% (9 patients out of 36) in control group (P = 0.040), these rates are compatible with previously mentioned ranges by Anand R and Boostrom SY. 6,7 This was accompanied by considerable reduction in the mean amount for drained fluid daily favoring also the study group. We suggest that this happened as normal reflection of cautious preservation of arm lymphatics that can be easily injured or divided during ALND and even if it is injured it could be easily visualized and ligated.…”

Section: Discussionmentioning

confidence: 93%

“…8 It results from cutting or ligation of upper limb lymphatics during axillary dissection. 7,9 The virtually unknown variations in arm lymphatic drainage put the arm lymphatics at risk for disruption during ALND. Therefore, mapping the drainage of the arm with blue dye and preserving the identified lymphatics would help in identification and decrease the likelihood of disruption of the lymphatics draining the arm during ALND.…”

Section: Introductionmentioning

confidence: 99%

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Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

et al. 2017

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INTRODUCTIONBreast cancer is the most common malignancy in women worldwide and its incidence increases every year.1 From the total female cancer cases in Egypt, breast cancer represented 35.1%. 2The primary site of lymphatic drainage of the breast is the axillary lymph nodes that involved in regional metastatic disease in breast cancer. Axillary lymph node dissection is the standard treatment of axillary lymph node metastasis. It is important for local control, staging and increase the possibility of survival benefit. 3Most of the serious complications after breast surgery are attributed to axillary lymph node dissection such as; lymphedema, seroma and major neurovascular injuries. 4 Seroma is the most common problem occurring after axillary lymph node dissection; excessive fluid accumulation usually stretches the skin and causes it to sag, resulting in patient discomfort, and delay of adjuvant ABSTRACT Background: Breast cancer is one of the most leading causes of cancer deaths in female. Surgical treatment is considered the corner stone in its management. Axillary lymph node dissection (ALND) is an integral step in most of surgeries done, however it has many morbidities like prolonged seroma and lymphedema. Axillary reverse mapping (ARM) procedure was first described in 2007 in a trial to map the axillary lymphatics of the arm and avoid its injury therefore lymph complications. Methods: A prospective, randomized, controlled study over 72 female patients who underwent modified radical mastectomy (MRM). Patients were divided and randomized into study and control groups, thirty-six patients for each. In study group the ARM procedure was done by injecting 2.5 ml of methylen blue dye intra-dermally and subcutaneously in the upper inner ipsilateral arm along the medial intramuscular groove before ALND. Operative and post-operative results were recorded. Follow up was 6 to 24 months. Results: ARM procedure and successful visualization of arm lymphatics was achieved in 31 patients (86.1%). Statistically there was no significant difference between the two groups regarding patient and tumour characteristics, operative time and number of excised L.Ns. There was significant difference favouring the ARM group in decreasing the incidence of seroma (p= 0.040), lymphedema (p= 0.031) and time passed till remove drains (p <0.001). Conclusions: ARM procedure facilitated arm lymphatics visualization. It is easy non-time-consuming procedure. It resulted in significant reduction in incidence of seroma and lymphedema, with considerable reduction in the overall complications rate.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

et al. 2017

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“…Seroma has been variously reported as occurring in 3-85% of patients undergoing ALND for breast cancer [6]. Though the etiology of the development of seroma in post-operative seroma formation remains doubtful, it occurs with almost equal frequency in mastectomy and BCS.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical site infection (SSI) has been reported to occur in 4.4% of breast cancers treated with surgery [6]. In many instances, it is associated with seroma formation, but it can occur independent of it.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Results of Breast Cancer Surgery: A 8 Yrs’ Experience

Gupta

Bhattacharya

Bhowmick

et al. 2010

Indian J Surg Oncol

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“…Recently, we have reported that seroma, an accrual of fluid reported after surgical procedures such as axillary lymph node dissection (19,20), is associated with an accumulation of afferent lymph drained from upstream tissues during the interval of time needed for lymphatic vessels to reanastomose with the efferent ducts after removal of lymph nodes (21). Further supporting this hypothesis, we reported the presence, in seroma fluids, of large mononuclear cells partially expressing CD14 and reminiscent of veiled cells detectable in afferent lymph (5,21).…”

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confidence: 99%

Characterization of Human Afferent Lymph Dendritic Cells from Seroma Fluids

Morandi

Bonaccorsi

Mesiti

et al. 2013

The Journal of Immunology

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Dendritic cells (DCs) migrate from peripheral tissues to secondary lymphoid organs (SLOs) through the afferent lymph. Owing to limitations in investigating human lymph, DCs flowing in afferent lymph have not been properly characterized in humans until now. In this study, DCs present in seroma, an accrual of human afferent lymph occurring after lymph node surgical dissection, were isolated and analyzed in detail. Two main DC subsets were identified in seroma that corresponded to the migratory DC subsets present in lymph nodes, that is, CD14+ and CD1a+. The latter also included CD1abright Langerhans cells. The two DC subsets appeared to share the same monocytic precursor and to be developmentally related; both of them spontaneously released high levels of TGF-β and displayed similar T cell–activating and –polarizing properties. In contrast, they differed in the expression of surface molecules, including TLRs; in their phagocytic activity; and in the expression of proteins involved in Ag processing and presentation. It is worth noting that although both subsets were detected in seroma in the postsurgical inflammatory phase, only CD1a+ DCs migrated via afferent lymph under steady-state conditions. In conclusion, the high numbers of DCs contained in seroma fluids allowed a proper characterization of human DCs migrating via afferent lymph, revealing a continuous stream of DCs from peripheral regions toward SLOs under normal conditions. Moreover, we showed that, in inflammatory conditions, distinct subsets of DCs can migrate to SLOs via afferent lymph.

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Incidence of Clinically Significant Seroma after Breast and Axillary Surgery

Cited by 66 publications

References 6 publications

Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

Role of axillary reverse mapping in decreasing complications after axillary dissection in breast cancer

Optimizing Results of Breast Cancer Surgery: A 8 Yrs’ Experience

Characterization of Human Afferent Lymph Dendritic Cells from Seroma Fluids

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