Strategies for Preventing Seroma in Patients Undergoing Breast Cancer Surgical Treatment: Systematic Literature Review
DOI:
https://doi.org/10.32635/2176-9745.RBC.2024v70n2.4616Keywords:
Breast Neoplasms/surgery, Seroma/prevention & control, ReviewAbstract
Introduction: Seroma is the most common scar complication in the postoperative period of breast cancer, which impacts patients’ quality of life and can lead to repeated punctures, new surgical procedures and delays in adjuvant treatment. Objective: Systematic review of the scientific literature on the procedures used to prevent seroma in patients undergoing surgical treatment for breast cancer, addressing their advantages and disadvantages. Method: Cochrane Collaboration-based methodology, including articles from clinical trials and observational studies. To identify relevant studies, the following databases were searched: MEDLINE via PubMed, PEDro, Cochrane Library and LILACS. The search was carried out from October 2022 to January 2023. The methodological quality of clinical trials was assessed using the PEDro scale and the Newcastle-Ottawa scale for observational studies. Results: 405 articles were identified and, after evaluation, 24 articles were included for analysis. There are several approaches that could minimize the incidence of seroma, as the use of a drain, obliteration of dead space, instruments used for tissue dissection and techniques that could control the inflammatory process. Conclusion: The seroma prevention strategies used in the studies minimized the incidence of seroma, with the exception of talc and iodine, however, the studies that focused on the obliteration of dead space, whether with quilting suture or sealant, showed more significant statistical results, suggesting that they are promising for seroma prevention.
Downloads
References
Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends--an update. Cancer Epidemiol Biomarkers Prev. 2016;25(1):16-27. doi: https://doi.org/10.1158/1055-9965.EPI-15-0578 DOI: https://doi.org/10.1158/1055-9965.EPI-15-0578
Tarantino P, Viale G, Press MF, et al. ESMO expert consensus statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol. 2023;34(8):645-59. doi: https://doi.org/10.1016/j.annonc.2023.05.008 DOI: https://doi.org/10.1016/j.annonc.2023.05.008
Santos MO, Lima FCS, Martins LFL, et al. Estimativa de incidência de câncer no Brasil, 2023-2025. Rev Bras Cancerol. 2023;69(1):e-213700. doi: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700 DOI: https://doi.org/10.32635/2176-9745.RBC.2023v69n1.3700
Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2022;20(6):691-722. doi: https://doi.org/10.6004/jnccn.2022.0030 DOI: https://doi.org/10.6004/jnccn.2022.0030
Czajka ML, Pfeifer C. Breast cancer surgery [Internet]. Treasure Island: StatPearls Publishing; 2024. [acesso 2024 jan 12]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK553076/
Al-Hilli Z, Wilkerson A. Breast surgery: management of postoperative complications following operations for breast cancer. Surg Clin North Am. 2021;101(5):845-63. doi: https://doi.org/10.1016/j.suc.2021.06.014 DOI: https://doi.org/10.1016/j.suc.2021.06.014
Jordan SW, Khavanin N, Kim JYS. Seroma in prosthetic breast reconstruction. Plast Reconstr Surg. 2016;137(4):1104-16. doi: https://doi.org/10.1097/01.prs.0000481102.24444.72 DOI: https://doi.org/10.1097/01.prs.0000481102.24444.72
Isozaki H, Yamamoto Y, Murakami S, et al. Impact of the surgical modality for axillary lymph node dissection on postoperative drainage and seroma formation after total mastectomy. Patient Saf Surg. 2019;13:20. doi: https://doi.org/10.1186/s13037-019-0199-z DOI: https://doi.org/10.1186/s13037-019-0199-z
Bosman J, Piller N. Lymph taping and seroma formation post breast cancer. J Lymphoedema. 2010;5(2):45-52.
Lin W, Yang Y, Zhong W, et al. The effect of low and high vacuum drainage on the postoperative drainage of breast cancer: insights from a prospective, noninferiority, randomized clinical trial. Cancer Manag Res. 2020;12:12487-96. doi: https://doi.org/10.2147/cmar.s283031 DOI: https://doi.org/10.2147/CMAR.S283031
Findik UY, Topcu SY, Vatansever O. Effects of drains on pain, comfort and anxiety in patients undergone surgery. Int J Caring Sci. 2013;6(3):412.
University of York. Centre for Reviews and Dissemination. New York: University of York; 2019. PROSPERO - International prospective register of systematic reviews. 2023. [acesso 2023 ago 31]. Disponível em: https://www.crd.york.ac.uk/PROSPERO/
PEDro: Escala PEDro [Internet]. Database Physiotherapy Evidence. Sydney: Universidade de Sydney; IMH; 1999. [acesso 2024 jan 23]. Disponível em: https://pedro.org.au/portuguese/resources/pedro-scale/
Wells GA, Shea B, O’Connell DA, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Oxford: The Ottawa Hospital Research Institute; 2000. [acesso 2024 jan 23]. Disponível em: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Page MJ, Moher D, Bossuyt PM, et al. Prisma 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. doi: https://doi.org/10.1136/bmj.n160 DOI: https://doi.org/10.1136/bmj.n160
Seenivasagam KR, Gupta V, Singh G. Prevention of seroma formation after axillary dissection--a comparative randomized clinical trial of three methods. Breast J. 2013;19(5):478-84. doi: https://doi.org/10.1111/tbj.12164 DOI: https://doi.org/10.1111/tbj.12164
Rooij L, van Kuijk SMJ, Granzier RWY, et al. reducing seroma formation and its sequelae after mastectomy by closure of the dead space: a multi-center, doubleblind randomized controlled trial (SAM-Trial). Ann Surg Oncol. 2021;28(5):2599-2608. doi: https://doi.org/10.1245/s10434-020-09225-8 DOI: https://doi.org/10.1245/s10434-020-09225-8
Benevento R, Santoriello A, Pellino G, et al. The effects of low-thrombin fibrin sealant on wound serous drainage, seroma formation and length of postoperative stay in patients undergoing axillary node dissection for breast cancer. A randomized controlled trial. Int J Surg.
;12(11):1210-5. doi: https://doi.org/10.1016/j.ijsu.2014.10.005 DOI: https://doi.org/10.1016/j.ijsu.2014.10.005
Kuş A, Yörükoğlu UH, Aksu C, et al. Efeito do bloqueio paravertebral torácico na redução de seroma em cirurgia de mama – estudo randomizado controlado. Braz J Anesthesiol. 2020;70(3):215-9. doi: https://doi.org/10.1016/j.bjan.2019.12.015 DOI: https://doi.org/10.1016/j.bjan.2019.12.015
Baker E, Piper J. Drainless mastectomy: is it safe and effective? Surgeon. 2017;15(5):267-71. doi: https://doi.org/10.1016/j.surge.2015.12.007 DOI: https://doi.org/10.1016/j.surge.2015.12.007
Vasileiadou K, Kosmidis C, Anthimidis G, et al. Cyanoacrylate adhesive reduces seroma production after modified radical mastectomy or quadrantectomy with lymph node dissection-a prospective randomized clinical trial. Clin Breast Cancer. 2017;17(8):595-600. doi: https://doi.org/10.1016/j.clbc.2017.04.004 DOI: https://doi.org/10.1016/j.clbc.2017.04.004
Piñero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrión J, et al. Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol. 2016;114(4):423-7. doi: https://doi.org/10.1002/jso.24344 DOI: https://doi.org/10.1002/jso.24344
Boeer B, Schneider J, Schoenfisch B, et al. Lysineurethane-based tissue adhesion for mastectomyan approach to reducing the seroma rate? Arch Gynecol Obstet. 2021;303(1):181-8. doi: https://doi.org/10.1007/s00404-020-05801-1 DOI: https://doi.org/10.1007/s00404-020-05801-1
Garza-Gangemi AM, Barquet-Muñoz SA, Villarreal-Colín SP, et al. Randomized phase II study of talc versus iodopovidone for the prevention of seroma formation following modified radical mastectomy. Rev Invest Clin. 2015;67(6):357-65.
Myint ST, Khaing KS, Yee W, et al. Quilting suture versus conventional closure in prevention of seroma after total mastectomy and axillary dissection in breast cancer patients. ANZ J Surg. 2020;90(7-8):1408-13. doi: https://doi.org/10.1111/ans.16091 DOI: https://doi.org/10.1111/ans.16091
Qvamme G, Axelsson CK, Lanng C, et al. Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection. Br J Surg. 2015;102(10):1195-203. doi: https://doi.org/10.1002/bjs.9874 DOI: https://doi.org/10.1002/bjs.9874
Zhao J, Su F, Hu Y, et al. Prospective comparison of Sapylin and Avitene for reducing hydrops after axillary lymphadenectomy in breast cancer patients. J Surg Res. 2017;210:8-14. doi: https://doi.org/10.1016/j.jss.2016.10.032 DOI: https://doi.org/10.1016/j.jss.2016.10.032
Yang Y, Gao E, Liu X, et al. Effectiveness of OK-432 (Sapylin) to reduce seroma formation after axillary lymphadenectomy for breast cancer. Ann Surg Oncol. 2013;20(5):1500-4. doi: https://doi.org/10.1245/s10434-012-2728-1 DOI: https://doi.org/10.1245/s10434-012-2728-1
Khan MA. Effect of preoperative intravenous steroids on seroma formation after modified radical mastectomy. J Ayub Med Coll Abbottabad. 2017;29(2):207-10.
ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, et al. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol. 2014;21(3):802-7. doi: https://doi.org/10.1245/s10434-013-3359-x DOI: https://doi.org/10.1245/s10434-013-3359-x
Ouldamer L, Caille A, Giraudeau B, et al. Quilting suture of mastectomy dead space compared with conventional closure with drain. Ann Surg Oncol. 2015;22(13):4233-40. doi: https://doi.org/10.1245/s10434-015-4511-6 DOI: https://doi.org/10.1245/s10434-015-4511-6
Mazouni C, Mesnard C, Cloutier AS, et al. Quilting sutures reduces seroma in mastectomy. Clin Breast Cancer. 2015;15(4):289-93. doi: https://doi.org/10.1016/j.clbc.2014.12.014 DOI: https://doi.org/10.1016/j.clbc.2014.12.014
Selvendran S, Cheluvappa R, Tr Ng VK, et al. Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance. Int J Surg. 2016;30:116-20. doi: https://doi.org/10.1016/j.ijsu.2016.04.041 DOI: https://doi.org/10.1016/j.ijsu.2016.04.041
Kong D, Liu Y, Li Z, et al. OK-432 (Sapylin) reduces seroma formation after axillary lymphadenectomy in breast cancer. J Invest Surg. 2017;30(1):1-5. doi: https://doi.org/10.1080/08941939.2016.1204386 DOI: https://doi.org/10.1080/08941939.2016.1204386
van Bastelaar J, Beckers A, Snoeijs M, et al. Flap fixation reduces seroma in patients undergoing mastectomy: a significant implication for clinical practice. World J Surg Oncol. 2016;14:66. doi: https://doi.org/10.1186/s12957-016-0830-8 DOI: https://doi.org/10.1186/s12957-016-0830-8
Conversano A, Mazouni C, Thomin A, et al. Use of low-thrombin fibrin sealant glue after axillary lymphadenectomy for breast cancer to reduce hospital length and seroma. Clin Breast Cancer. 2017;17(4):293-7. doi: https://doi.org/10.1016/j.clbc.2016.12.013 DOI: https://doi.org/10.1016/j.clbc.2016.12.013
van Bastelaar J, Theunissen LLB, Snoeijs MGJ, et al. Flap fixation using tissue glue or sutures appears to reduce seroma aspiration after mastectomy for breast cancer. Clin Breast Cancer. 2017;17(4):316-21. doi: https://doi.org/10.1016/j.clbc.2017.01.005 DOI: https://doi.org/10.1016/j.clbc.2017.01.005
Huang J, Wang S, Wu Y, et al. Conventional suture with prolonged timing of drainage is as good as quilting suture in preventing seroma formation at pectoral area after mastectomy. World J Surg Oncol. 2021;19(1):148. doi: https://doi.org/10.1186/s12957-021-02257-8 DOI: https://doi.org/10.1186/s12957-021-02257-8
van Zeelst LJ, Ten Wolde B, van Eekeren RRJP, et al. Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort. J Surg Oncol. 2022;125(3):369-76. doi: https://doi.org/10.1002/jso.26739 DOI: https://doi.org/10.1002/jso.26739
Gambardella C, Clarizia G, Patrone R, et al. Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation. BMC Surg. 2019;18(Suppl 1):125. doi: https://doi.org/10.1186/s12893-018-0454-8 DOI: https://doi.org/10.1186/s12893-018-0454-8
Srivastava V, Basu S, Shukla VK. Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer. 2012;15(4):373-80. doi: https://doi.org/10.4048/jbc.2012.15.4.373 DOI: https://doi.org/10.4048/jbc.2012.15.4.373
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
