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

He, Xiaodong; Guo, Zhi‐Hui; Tian, Jinhui; Yang, Kehu; Xie, Xiaodong

doi:10.1007/s12032-010-9673-2

Cited by 54 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies have shown that the omission of a drain is associated with a shorter hospital stay and less post-surgical pain, but also with an increase in seroma aspirations [2,3,4,5,6]. In the past, various risk factors like breast size, age, blood pressure, and number of tumor-infiltrated lymph nodes have been evaluated [2,3].…”

Section: Introductionmentioning

confidence: 99%

Should a Drain Be Placed in Early Breast Cancer Surgery?

et al. 2014

View full text Add to dashboard Cite

Background: The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. This reduction in surgical procedures calls the need for a drain into question. Method: Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score. Results: The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. The data regarding wound infection and drain insertion is inconclusive. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in out-patient seroma aspirations. Conclusion: The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments.

show abstract

Section: Introductionmentioning

confidence: 99%

Should a Drain Be Placed in Early Breast Cancer Surgery?

et al. 2014

View full text Add to dashboard Cite

show abstract

“…22 There are data regarding lymph node dissection (LND) at other surgical sites, which suggest that drains reduce the incidence of seromas, as well as seroma volume and need for aspiration. 23 It is possible that the risk of seroma is related to the extent of LND performed. However, a high percentage of patients (83%) in the present study had LND with a median number of lymph nodes removed, exceeding those of most reported open RRP or RALP series.…”

Section: Discussionmentioning

confidence: 99%

Impact of Routine Use of Surgical Drains on Incidence of Complications with Robot-Assisted Radical Prostatectomy

Musser

Assel

Guglielmetti

et al. 2014

Journal of Endourology

View full text Add to dashboard Cite

Purpose: To assess the impact of eliminating routine drain placement in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND) on the risk of postoperative complications. Patients and Methods: An experienced single surgeon performed RALP on 651 consecutive patients at our institution from 2008 to 2012. Before August 2011, RALP with or without PLND included a routine peritoneal drain placed during surgery. Thereafter, routine intraoperative placement of drains was omitted, except for intraoperatively noted anastomotic leakage. We used multivariable logistic regression to compare complication rates between study periods and the actual drain placement status after adjusting for standard prespecified covariates. Results: Most patients (92%) did not have ‡ grade 2 complications after surgery and only two patients (0.3%) experienced a grade 4 complication. The absolute adjusted risk of a grade 2-5 complication was 0.9% greater among those treated before August 2011 (95% confidence interval [CI] -3.3%-5.1%; p = 0.7), while absolute adjusted risk of a grade 3-5 complication was 2.8% less ( -2.8%; 95% CI -5.3%-0.1%; p = 0.061). Results based on drain status were similar. Conclusions: Routine peritoneal drain placement following RALP with PLND did not confer a significant advantage in terms of postoperative complications. Further data are necessary to confirm that it is safe to omit drains in most patients.

show abstract

“…Para evitar este acúmulo de linfa postoperatorio, el único método que ha demostrado ser eficaz hasta la fecha es la colocación de un drenaje en el lecho quirúrgico, que exteriorice el líquido y evite su acumulación 10 . Este drenaje debe ser mantenido en el tiempo hasta que su débito prác-ticamente desaparezca, lo que implica o una mayor estancia hospitalaria o la incomodidad del manejo del drenaje de forma ambulatoria [2][3][4] . Durante la disección axilar no sólo se seccionan los canalículos linfáticos, que originan la extravasación de la linfa al espacio intersticial, sino que la propia agresión quirúrgica desencadena una respuesta inflamatoria.…”

Section: Discussionunclassified

“…En la cirugía de la LA se coloca un drenaje en el hueco axilar, que se mantiene varios días con el fin de reducir la aparición de seroma y posterior sobreinfección a absceso axilar 2 . No obstante, el mantenimiento de este drenaje implica un aumento de la estancia hospitalaria hasta su retirada 3 o que el paciente sea dado de alta antes con el drenaje, lo que disminuye el confort y aumenta el impacto psicológico de la enfermedad 2,4 .…”

Section: Factores Asociados a Mayor Débito De Drenaje Tras Linfadenecunclassified

Factores asociados a mayor débito de drenaje tras linfadenectomía axilar por cáncer de mama

C³

et al. 2013

Rev Chil Cir

View full text Add to dashboard Cite

Factors associated with greater debit drainage after axillary lymphadenectomy for breast cancer Introduction: Axillary lymph node dissection (ALND) is still a usual procedure in the treatment of breast cancer. A drain is normally placed in the surgical bed and maintained several days until obtaining a daily discharge of 30-50 ml, in order to reduce the appearance of seroma. The aim of this study was to analyze possible factors associated with an increased drainage volume. Patients and Methods: A retrospective study of all the patients undergoing ALND for breasts cancer at our institution between 2011 and 2012 was performed. Results: 40 females were included. There were no complications or mortality. Median hospital stay was 2 days. Median day of drainage removal was the 5th postoperative day. Mean total drainage volume was 298.9 ± 240.1 ml. High blood pressure associated with an increased drainage volume (550 ml vs 217.5 ml; p = 0.001) and a later removal (8 th vs 4 th day; p = 0.002). Similar happened with age > 65 years (420.8 ml vs 24.6 ml; p = 0.003) and (7th vs 5 th day; p = 0.009). The number of metastatic lymph nodes showed a direct correlation with total drainage volume (Pearson 0.503; p = 0.017) and removal day (Spearman 0.563; p = 0.006), similar to the primary tumour size: Total drainage volume (Pearson 0.447; p = 0.042) and removal day (Spearman 0.556; p = 0.009). Conclusion: Age over 65 years, high blood pressure, number of metastatic lymph nodes and primary tumour size associated with a higher drainage volume and time to remove the drain.

show abstract

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

Cited by 54 publications

References 29 publications

Should a Drain Be Placed in Early Breast Cancer Surgery?

Should a Drain Be Placed in Early Breast Cancer Surgery?

Impact of Routine Use of Surgical Drains on Incidence of Complications with Robot-Assisted Radical Prostatectomy

Factores asociados a mayor débito de drenaje tras linfadenectomía axilar por cáncer de mama

Contact Info

Product

Resources

About