COMPARISON OF AXILLARY DRAIN OUT PUT IN CONVENTIONAL AND ADVANCEDCOMPRESSIVE ENERGY SOURCE LIKE ULTRASONIC SCALPEL AND LIGASURE DISSECTION OF AXILLA IN BREAST CANCER SURGERY
AbstractBackground: Breast cancer is the most common malignancy worldwide. Surgical treatment of axilla is a part of treatment of locally advanced breast cancer. Conventional knot tying plus electrocautery and advanced compressive energy sources are used to reduce the continued axillary serous fluid discharge when drains are in place and seroma formation afterwards. Methods: This double-blind comparative study was carried out between April 2018 to October 2019. In total 180 patients undergoing axillary dissection for treatment of locally advanced breast cancer were recruited. Patients were divided into two groups (C and H) depending upon method of dissection used for axillary surgery. Results: For most participants, amount of axillary drain volume in Group C was between 400-700ml (in 48.9% participants) and for Group H more than 700 ml (in 44.4% participants). This difference is not statistically significant (p=0.288). Duration of hospital stay (p=0.003) and duration of drain placement was significantly longer (p=0.019) for most participants in Group H. More hospital visits were required for the said group. There was statistically significant co-relation between immediate complications and haemostasis techniques (p=0.003) with more incidence of Seroma noticed in Group H than in Group C. Conclusion: Current study shows limited benefits of using ultrasonic scalpels in breast cancer surgeries. Variables such as BMI, Age and chemotherapy need to be controlled in order to derive a true comparison.
Fan L, Goss PE, Strasser-Weippl K. Current status and future projections of breast cancer in Asia. Breast Care (Basel) 2015;10(6):372–8.
Tao, Z., Shi, A., Lu, C. et al. Breast Cancer: Epidemiology and Etiology. Cell Biochem Biophys 72, 333–338 (2015). https://doi.org/10.1007/s12013-014-0459-6.
Smith GL, Xu Y, Shih YC, Giordano SH, Smith BD, Hunt KK, et al. Breast conserving surgery in older patients with invasive breast cancer: current patterns of treatment across United States. J Am Coll Surg 2009;209(4):425–33.
Greenburg CC, Lipsit SR, Hughes ME, Edge SB, Theriault R, Wilson JL, et al. Instituitional variations in surgical treatment of breast cancer: a study of the NCCN. Ann Surg 2011;254(2):339–45.
Colleoni M, Gelber RD. Time to Initiation of Adjuvant Chemotherapy for Early Breast Cancer and Outcome: The Earlier, the Better? J Clin Oncol 2014,32(8):717–9.
Vandergrift JL, Niland JC, Theriault RL, Edge SB, Wong YN, Loftus LS, et al. Time to adjuvant Chemotherapy for breast cancer in National Comprehensive Cancer Network institutions. J Natl Cancer Inst 2013;105(2):104–12.
Gagliato DDM, Gonzalez-Angulo AM, Lei X, Theriault RL, Giordano SH, Valero V, et al. Clinical impact of Delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol 2014;32(8):735–44.
Vitug AF, Newman LA. Complications in breast surgery. Surg Clin North Am 2007;87(2):431–51.
Coveney EC, O’Dwyer PJ, Geraghty JG, O’Higgins NJ. Effect of closing dead space on seroma formation after mastectomy-aprospective randomized clinical trial. Eur J Surg Oncol 1993;19(2):143–6.
A.J.M., Bemmel V, van de Velde C.J.H, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: A systematic review. EJSO 2011
; 37 (10): 829-35. ISSN 0748-7983.
Sajid MS, Hutson KH, Rapisarda IF, Bonomi R. Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery. Cochrane Database Syst Rev 2013;5:CD009557.
Iovino F, Auriemma PP, Ferraraccio F, Antoniol G, Barbarisi A. Preventing seroma formation after axillary dissection for breast cancer:a randomized clinical trial. Am J Surg 2012;203(6):708–14.
Miccoli P, Materazzi G, Miccoli M, Frustaci G, Fosso A, Berti P. Evaluation of a new ultrasonic device in thyroid surgery: comparative randomized study. Am J Surg 2010;199(6):736–40.
Kandil,T,NakeebEl, Hefnawy El. Comparative Study between Clipless Lparoscopic Cholecystectomy by Harmonic Scalpel versus Conventional Method: A Prospective Randomized Study. J Gastrointest Surg 2010;14(2):323–8.
Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robotic – assisted laparoscopic extended right hepatectomy with biliary reconstruction: J Laparoendosc Adv Surg Tech A 2010;20(2):159–63.
Porter KA, O’Connor S, Rimm E, Lopez M. Electrocautery as a factor in seroma formation following mastectomy. Am J Sur 1998;176(1):8–11.
Sutton PA, Awad S, Perkins AC, Lobo DN. Comparison of lateral Thermal spread using monopolar and bipolar diathermy, the Harmonic Scalpel and the Ligasure. Br J Surg 2010;97(3):428–33.
Deo SV, Shukla NK. Modified radical mastectomy using harmonic scalpel. J Surg Oncol 2000;74(3):204–7.
Galatius H, Okholm M, Hoffmann J. Mastectomy using ultrasonic dissection: effect on seroma formation. Breast 2003;12(5):338–41.
Adwani A, Ebbs SR. Ultracision reduces acute blood loss but not Seroma formation after mastectomy and axillary dissection: a pilot study. Int J Clin Pract 2006;60(5):562–4.
Kontos M, Kothari A, Hamed H. Effect of harmonic scalpel on seromaformation following surgery for breast cancer: a prospective randomized study. J BUON 2008;13(2):223–30.
Sanguinetti A, Docimo G, Ragusa M, Calzolari F, D’Ajello F, Ruggiero R, et al. Ultrasound scissors versus electrocautery in axillary dissection: Our experience. G Chir 2010;31(4):151–3.
Nawaz A, WaqarS, Khan A, Mansoor R, Butt U, Ayyaz M. Harmonic scalpel versus electrocautery in axillary dissection in carcinoma breast. J Coll Physicians Surg Pak 2015;25(12):870–3.
Deo SV, Shukla NK, Asthana S, Niranjan B, Srinivas G. A comparative study of modified radical mastectomy using harmonic scalpel and electrocautery. Singapore Med J 2002;43(5):226–8.
Rohaizak M1, Khan FJ, Jasmin JS, Mohd Latar NH, Abdullah SS. Ultracision versus electrocautery in performing modified radical mastectomy and axillary lymph node dissection for breast cancer: a prospective randomized control trial. Med J Malaysia 2013;68(3):204–7.
Burdette TE1, Kerrigan CL, Homa K. Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial. Plast Reconstr Surg 2011;128(4):e243–249.
Shanmugam S, Govindasamy G, Hussain SA, Rao PSH. Axillary dissection for breast cancer using electrocautery versus ultrasonic dissectors: A prospective randomized study. Indian J Cancer 2017;54(3):543–6.
Yilmaz KB1, Dogan L, Nalbant H, Akinci M, Karaman N, Ozaslan C, et al. Comparing scalpel, electrocautery and ultrasonic dissector effects: the impact on wound complications and pro-inflammatory cytokine levels in wound fluid from mastectomy patients. J Breast Cancer 2011;14(1):58–63.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.