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Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons

  • Breast Oncology
  • Published:
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Abstract

Introduction

Seroma formation after axillary lymph node dissection (ALND) remains a troublesome complication with significant morbidity. Numerous studies have tried to identify techniques to prevent seroma formation. The aim of this systematic review and network meta-analysis is to use available literature to identify the best intervention for prevention of seroma after standalone ALND.

Methods

A literature search was performed for all comparative articles regarding seroma formation in patients undergoing a standalone ALND or ALND with breast-conserving surgery in the last 25 years. Data regarding seroma formation, clinically significant seroma (CSS), surgical site infections (SSI), and hematomas were collected. The network meta-analysis was performed using a random effects model and the level of inconsistency was evaluated using the Bucher method.

Results

A total of 19 articles with 1962 patients were included. Ten different techniques to prevent seroma formation were described. When combining direct and indirect comparisons, axillary drainage until output is less than 50 ml per 24 h for two consecutive days results in significantly less CSS. The use of energy sealing devices, padding, tissue glue, or patches did not significantly reduce the incidence of CSS. When comparing the different techniques with regard to SSIs, no statistically significant differences were seen.

Conclusions

To prevent CSS after ALND, axillary drainage is the most valuable and scientifically proven measure. On the basis of the results of this systematic review with network meta-analysis, removing the drain when output is < 50 ml per 24 h for two consecutive days irrespective of duration seems best. Since drainage policies vary widely, an evidence-based guideline is needed.

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Authors and Affiliations

  1. Department of Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands

    Merel A. Spiekerman van Weezelenburg MD, Maikel J. A. M. Bakens MD, PhD, Jean H. T. Daemen MD, PhD, Loeki Aldenhoven MSc, Elisabeth R. M. van Haaren MD, Alfred Janssen MD, Yvonne L. J. Vissers MD, PhD & James van Bastelaar MD, PhD

  2. Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Geerard L. Beets MD, PhD

  3. GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands

    Geerard L. Beets MD, PhD

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  1. Merel A. Spiekerman van Weezelenburg MD
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Correspondence to Merel A. Spiekerman van Weezelenburg MD.

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Spiekerman van Weezelenburg, M.A., Bakens, M.J.A.M., Daemen, J.H.T. et al. Prevention of Seroma Formation and Its Sequelae After Axillary Lymph Node Dissection: An Up-to-Date Systematic Review and Guideline for Surgeons. Ann Surg Oncol 31, 1643–1652 (2024). https://doi.org/10.1245/s10434-023-14631-9

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