![]() ![]() The 3 studies reviewed found a highly significant difference. also reported the number of seroma aspirations. 2 reviews each included 6 studies, with 3 studies reviewed in both reviews. , the insertion of a drain reduces the amount of seroma produced. Details regarding the included reviews are given in table 1.Īccording to Droeser et al. This resulted in a low Jadad score and the article was therefore also excluded. compared subgroups of 2 different independent prospective studies. conducted retrospective studies and these articles were therefore also excluded. This left the 3 articles from Taylor et al. Articles investigating different instruments/surgical techniques, postsurgical physiotherapy, or breast infections without relation to the insertion of drains were excluded. The same systematic approach was used for the time period after January 2012, looking for randomized controlled trails (fig. This left 5 systematic reviews relevant to the question, in which a total of 1,075 patients were included (537 cases and 538 controls). The impact of physiotherapy or diet was researched, but again the intrasurgical drains were not considered. Other authors published on primary breast infections occurring without breast surgery or on breast wound dressing. 3 articles investigated the impact of different instruments/fibrin glue on seroma production. Materials and Methodsįrom the analysis, 9 articles were excluded for not answering the primary question. BCS includes mastectomy, breast-conserving surgery, biopsy (WLE), ALNE, and SNB dissection. We looked for reviews regarding early BCS with and without drain, to identify evidence-based information on the omission of a wound drain. Several reports show that the omission of a drain is possible, and in some studies an influence on the number of wound infections, increased pain, and prolonged hospital stays are discussed as a result of drains after breast surgery. In light of the American College of Surgeons Oncology Group Z0011 study, which questions the need for ALNE, we ask if there is still a need for a wound drain in early BCS. Despite this, the medical benefit of a drain after BCS has not been established. In the past, various risk factors like breast size, age, blood pressure, and number of tumor-infiltrated lymph nodes have been evaluated. Studies have shown that the omission of a drain is associated with a shorter hospital stay and less post-surgical pain, but also with an increase in seroma aspirations. With the insertion of a drain these side effects should be positively influenced. Conclusion: The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in out-patient seroma aspirations. The data regarding wound infection and drain insertion is inconclusive. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. Results: The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score. Method: Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. This reduction in surgical procedures calls the need for a drain into question. Background: The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. ![]()
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