Axillary lymphadenectomy for breast cancer without axillary drainage
S. S. Jeffrey, W. H. Goodson 3rd, D. M. Ikeda, R. L. Birdwell and M. S. Bogetz
Department 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.
