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Axillary Padding as an Alternative to Closed Suction Drain for Ambulatory Axillary Lymphadenectomy
A Prospective Cohort of 207 Patients With Early Breast Cancer
Jean-Marc Classe, MD;
Pierre François Dupre, MD;
Thierry François, MD;
Serge Robard, MD;
Jean Loup Theard, MD;
François Dravet, MD
Arch Surg. 2002;137:169-172.
Hypothesis Axillary lymphadenectomy performed without the use of a drain but with padding of the axilla is feasible and safe on an outpatient basis in the setting of conservative surgery for breast cancer.
Design Prospective clinical study.
Setting Public oncology center.
Patients Two hundred seven patients were treated in our oncology center between January 11 and December 28, 1999, by means of this method of axillary lymphadenectomy based on axillary padding without a drain. One-day surgery was offered to each patient.
Intervention At the end of each functional axillary lymphadenectomy, the axilla was padded with the use of axillary aponeurosis and local muscles. Axillary suction drains were not used at all in this series of patients.
Main Outcome Measures Prospective assessment was performed, without randomization, with regard to the length of hospital stay, the reasons for postoperative conversion from 1-day surgery to traditional hospitalization, and postoperative complications.
Results Eighty-seven (42.0%) of the 207 patients underwent a 1-day procedure. In the 1-day surgery group, 87 (84.5%) of the 103 patients benefited from a true 1-day surgery procedure. The main reasons for conversion were nausea and anxiety rather than surgical complications. Hospital stay never exceeded 3 days. The most common postoperative complication was axillary seroma, with an average incidence of 22.2%.
Conclusion Breast-preserving surgery with axillary lymphadenectomy and padding of the axilla, precluding the use of a drain, is feasible and safe on a 1-day surgery basis for selected consenting patients.
From the Surgery (Drs Classe, Dupre, and Dravet) and Anesthesiology (Drs François, Robard, and Theard) Units, Centre de Lutte Contre le Cancer, Rene Gauducheau, Nantes Saint-Herblain, France.
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