Seroma formation after surgery for breast cancer
Identifieur interne : 001C23 ( Pmc/Corpus ); précédent : 001C22; suivant : 001C24Seroma formation after surgery for breast cancer
Auteurs : Esmat Hashemi ; Ahmad Kaviani ; Masoume Najafi ; Mandana Ebrahimi ; Homeira Hooshmand ; Ali MontazeriSource :
- World Journal of Surgical Oncology [ 1477-7819 ] ; 2004.
Abstract
Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation.
A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios.
A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery.
The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.
Url:
DOI: 10.1186/1477-7819-2-44
PubMed: 15588301
PubMed Central: 543447
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Seroma formation after surgery for breast cancer</title><author><name sortKey="Hashemi, Esmat" sort="Hashemi, Esmat" uniqKey="Hashemi E" first="Esmat" last="Hashemi">Esmat Hashemi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Kaviani, Ahmad" sort="Kaviani, Ahmad" uniqKey="Kaviani A" first="Ahmad" last="Kaviani">Ahmad Kaviani</name><affiliation><nlm:aff id="I2">Tehran University of Medical Sciences, Faculty of Medicine, Department of Surgery, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Najafi, Masoume" sort="Najafi, Masoume" uniqKey="Najafi M" first="Masoume" last="Najafi">Masoume Najafi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Ebrahimi, Mandana" sort="Ebrahimi, Mandana" uniqKey="Ebrahimi M" first="Mandana" last="Ebrahimi">Mandana Ebrahimi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Hooshmand, Homeira" sort="Hooshmand, Homeira" uniqKey="Hooshmand H" first="Homeira" last="Hooshmand">Homeira Hooshmand</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Montazeri, Ali" sort="Montazeri, Ali" uniqKey="Montazeri A" first="Ali" last="Montazeri">Ali Montazeri</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">15588301</idno><idno type="pmc">543447</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC543447</idno><idno type="RBID">PMC:543447</idno><idno type="doi">10.1186/1477-7819-2-44</idno><date when="2004">2004</date><idno type="wicri:Area/Pmc/Corpus">001C23</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C23</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Seroma formation after surgery for breast cancer</title><author><name sortKey="Hashemi, Esmat" sort="Hashemi, Esmat" uniqKey="Hashemi E" first="Esmat" last="Hashemi">Esmat Hashemi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Kaviani, Ahmad" sort="Kaviani, Ahmad" uniqKey="Kaviani A" first="Ahmad" last="Kaviani">Ahmad Kaviani</name><affiliation><nlm:aff id="I2">Tehran University of Medical Sciences, Faculty of Medicine, Department of Surgery, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Najafi, Masoume" sort="Najafi, Masoume" uniqKey="Najafi M" first="Masoume" last="Najafi">Masoume Najafi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Ebrahimi, Mandana" sort="Ebrahimi, Mandana" uniqKey="Ebrahimi M" first="Mandana" last="Ebrahimi">Mandana Ebrahimi</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Hooshmand, Homeira" sort="Hooshmand, Homeira" uniqKey="Hooshmand H" first="Homeira" last="Hooshmand">Homeira Hooshmand</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author><author><name sortKey="Montazeri, Ali" sort="Montazeri, Ali" uniqKey="Montazeri A" first="Ali" last="Montazeri">Ali Montazeri</name><affiliation><nlm:aff id="I1">Iranian Center for Breast Cancer, Tehran, Iran</nlm:aff></affiliation></author></analytic><series><title level="j">World Journal of Surgical Oncology</title><idno type="eISSN">1477-7819</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation.</p></sec><sec sec-type="methods"><title>Patients and methods</title><p>A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios.</p></sec><sec><title>Results</title><p>A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery.</p></sec><sec><title>Conclusion</title><p>The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Surg Oncol</journal-id><journal-title>World Journal of Surgical Oncology</journal-title><issn pub-type="epub">1477-7819</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">15588301</article-id><article-id pub-id-type="pmc">543447</article-id><article-id pub-id-type="publisher-id">1477-7819-2-44</article-id><article-id pub-id-type="doi">10.1186/1477-7819-2-44</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Seroma formation after surgery for breast cancer</article-title></title-group><contrib-group><contrib id="A1" contrib-type="author"><name><surname>Hashemi</surname><given-names>Esmat</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>hashemi@icbc.ir</email></contrib><contrib id="A2" contrib-type="author"><name><surname>Kaviani</surname><given-names>Ahmad</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>akaviani@sina.tums.ac.ir</email></contrib><contrib id="A3" contrib-type="author"><name><surname>Najafi</surname><given-names>Masoume</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>najafi@icbc.ir</email></contrib><contrib id="A4" contrib-type="author"><name><surname>Ebrahimi</surname><given-names>Mandana</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>ebrahimi@icbc.ir</email></contrib><contrib id="A5" contrib-type="author"><name><surname>Hooshmand</surname><given-names>Homeira</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>hooshmand@icbc.ir</email></contrib><contrib id="A6" corresp="yes" contrib-type="author"><name><surname>Montazeri</surname><given-names>Ali</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>ali@jdcord.jd.ac.ir</email></contrib></contrib-group><aff id="I1"><label>1</label>Iranian Center for Breast Cancer, Tehran, Iran</aff><aff id="I2"><label>2</label>Tehran University of Medical Sciences, Faculty of Medicine, Department of Surgery, Tehran, Iran</aff><pub-date pub-type="collection"><year>2004</year></pub-date><pub-date pub-type="epub"><day>9</day><month>12</month><year>2004</year></pub-date><volume>2</volume><fpage>44</fpage><lpage>44</lpage><ext-link ext-link-type="uri" xlink:href="http://www.wjso.com/content/2/1/44"></ext-link><history><date date-type="received"><day>8</day><month>9</month><year>2004</year></date><date date-type="accepted"><day>9</day><month>12</month><year>2004</year></date></history><permissions><copyright-statement>Copyright © 2004 Hashemi et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2004</copyright-year><copyright-holder>Hashemi et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0"></ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p><pmc-comment>
Hashemi
Esmat
hashemi@icbc.ir
Seroma formation after surgery for breast cancer
2004 World Journal of Surgical Oncology 2(1): 44-. (2004) 1477-7819(2004)2:1<44> urn:ISSN:1477-7819
</license></permissions><abstract><sec><title>Background</title><p>Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation.</p></sec><sec sec-type="methods"><title>Patients and methods</title><p>A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios.</p></sec><sec><title>Results</title><p>A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery.</p></sec><sec><title>Conclusion</title><p>The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.</p></sec></abstract></article-meta></front><body><sec><title>Background</title><p>Breast cancer is the second leading cause of cancer death among women. The surgical treatment of choice for these patients is either modified radical mastectomy or breast preservation depending upon stage of the disease. Seroma formation is the most frequent postoperative complication after breast cancer surgery. It occurs in most patients after mastectomy and is now increasingly being considered side effect of surgery rather than a complication however, all patients are not clinically symptomatic [<xref ref-type="bibr" rid="B1">1</xref>]. Seroma is defined as a serous fluid collection that develops under the skin flaps during mastectomy or in the axillary dead space after axillary dissection [<xref ref-type="bibr" rid="B2">2</xref>]. Incidence of seroma formation after breast surgery varies between 2.5% and 51% [<xref ref-type="bibr" rid="B3">3</xref>-<xref ref-type="bibr" rid="B5">5</xref>]. Although seroma is not life threatening, it can lead to significant morbidity (e.g. flap necrosis, wound dehiscence, predisposes to sepsis, prolonged recovery period, multiple physician visits) and may delay adjuvant therapy [<xref ref-type="bibr" rid="B6">6</xref>,<xref ref-type="bibr" rid="B7">7</xref>]. Fluid collection is ideally managed by repeated needle aspiration to seal the skin flaps against the chest wall. Several factors have been investigated as the cause of seroma formation these include age, duration of wound drainage, use of pressure garment, postoperative arm activity, preoperative chemotherapy, and use of electrocautery [<xref ref-type="bibr" rid="B3">3</xref>,<xref ref-type="bibr" rid="B8">8</xref>-<xref ref-type="bibr" rid="B12">12</xref>]. The present study was undertaken to identify risk-factors associated with seroma formation after breast cancer surgery.</p></sec><sec sec-type="methods"><title>Patients and methods</title><p>A cross sectional study of a consecutive sample of 158 patients attending the breast cancer clinic between January 2000 to October 2002 in Tehran, Iran, was carried out. All patients undergoing surgical therapy [modified radical mastectomy (MRM) or breast preservation (BP)] were included. Level II axillary lymph node dissection was performed for both groups. None of the patients underwent immediate reconstruction. The demographic data and clinical information were extracted from case records. Axillary seroma was defined as any clinically apparent fluid collection in the axilla or under the skin flaps and was treated with multiple needle aspirations. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. To analyze data univariate odds ratio (or relative risk) was calculated using Chi-square tests or regression analysis and this was followed by the multivariate logistic regression analysis to evaluate independent risk factors related to seroma formation. The variables of interest were selected in a single step (enter method), classification cut off was set at 0.5, probably of step for entry into the model was set at 0.05 and removal at 0.1, and the model was set to converge in maximum of 20 iterations. All variables under study were considered as independent predicting factors and seroma formation was considered as dependent variable for multivariate analysis. The study was approved by the institutional ethics committee.</p></sec><sec><title>Results</title><p>In all, 158 breast cancer patients were recruited into the study and 55 patients developed seroma, giving an overall incidence of 35% for seroma formation after breast surgery. The mean age of patients was 46.3 years (SD ± 11.9). One hundred and fifteen patients (73%) underwent MRM and BP was performed in 43 patients (27%). The axillary node involvement was significantly different between MRM and BP patients (χ<sup>2 </sup>= 4.52, df = 1, P = 0.03) indicating that those who underwent MRM had higher rate of positive axillary nodes compared to those who received BP (78% vs. 21% respectively). Thirty-one mastectomies were performed by scalpel dissection of the skin flap (20%) and 127 by cautery dissection (80%). Two closed suction drains were placed in all patients undergoing surgery. Sixty-six percent of patients (n = 104) were node positive and the remaining 34% (n = 54) were node negative. The patients' characteristics and univariate odds ratios are shown in Table <xref ref-type="table" rid="T1">1</xref>.</p><table-wrap position="float" id="T1"><label>Table 1</label><caption><p>The characteristics of patients in seroma and no seroma groups and univariate odds ratio.</p></caption><table frame="hsides" rules="groups"><thead><tr><td></td><td align="left"><bold>Seroma group (n = 55) n. (%)</bold></td><td align="left"><bold>No seroma group (n = 103) n. (%)</bold></td><td align="left"><bold>OR (95% CI)*</bold></td><td align="left"><bold>p value**</bold></td></tr></thead><tbody><tr><td align="left"><bold><italic>Age (years)</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.22</italic></td></tr><tr><td align="left"><40</td><td align="left">12 (21.8)</td><td align="left">34 (33.0)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">40–49</td><td align="left">20 (36.4)</td><td align="left">38 (36.9)</td><td align="left">1.49 (0.63–3.49)</td><td></td></tr><tr><td align="left">>50</td><td align="left">23 (41.8)</td><td align="left">31 (30.1)</td><td align="left">2.10 (0.89–4.92)</td><td></td></tr><tr><td align="left"><bold><italic>Tumor size (cm)</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.64</italic></td></tr><tr><td align="left"><2</td><td align="left">21 (38.2)</td><td align="left">47 (45.6)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">2–5</td><td align="left">21 (38.2)</td><td align="left">34 (33.0)</td><td align="left">1.42 (0.67–3.01)</td><td></td></tr><tr><td align="left">>5</td><td align="left">13 (23.6)</td><td align="left">22 (21.3)</td><td align="left">1.26 (0.53–2.96)</td><td></td></tr><tr><td align="left"><bold><italic>Nodal involvement (n = 152)</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.31</italic></td></tr><tr><td align="left">No</td><td align="left">14 (26.4)</td><td align="left">34 (36.8)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">Yes</td><td align="left">39 (73.6)</td><td align="left">65 (65.7)</td><td align="left">1.45 (0.69–3.04)</td><td></td></tr><tr><td align="left"><bold><italic>Surgical procedure</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.03</italic></td></tr><tr><td align="left">Breast conservation</td><td align="left">10 (18.2)</td><td align="left">33 (32.0)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">Modified radical mastectomy</td><td align="left">45 (81.8)</td><td align="left">70 (68.0)</td><td align="left">2.12 (0.95–4.72)</td><td></td></tr><tr><td align="left"><bold><italic>Surgical instrument</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.06</italic></td></tr><tr><td align="left">Scalpel</td><td align="left">8 (14.5)</td><td align="left">23 (22.3)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">Cautery</td><td align="left">47 (85.5)</td><td align="left">80 (77.7)</td><td align="left">1.68 (0.70–4.07)</td><td></td></tr><tr><td align="left"><bold><italic>Neoadjuvant chemotherapy</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.22</italic></td></tr><tr><td align="left">No</td><td align="left">46 (83.6)</td><td align="left">93 (90.3)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">Yes</td><td align="left">9 (16.4)</td><td align="left">10 (9.7)</td><td align="left">1.82 (0.69–4.78)</td><td></td></tr><tr><td align="left"><bold><italic>Pressure garment</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.63</italic></td></tr><tr><td align="left">Yes</td><td align="left">12 (21.8)</td><td align="left">26 (25.2)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">No</td><td align="left">43 (78.2)</td><td align="left">77 (74.8)</td><td align="left">1.21 (0.55–2.63)</td><td></td></tr><tr><td align="left"><bold><italic>Axillary drainage time (days/n= 152)</italic></bold></td><td></td><td></td><td></td><td align="left"><italic>0.64</italic></td></tr><tr><td align="left">>10</td><td align="left">8 (15.1)</td><td align="left">20 (20.2)</td><td align="left">1.00 (ref.)</td><td></td></tr><tr><td align="left">5–10</td><td align="left">30 (56.6)</td><td align="left">49 (49.5)</td><td align="left">1.53 (0.59–3.90)</td><td></td></tr><tr><td align="left"><5</td><td align="left">15 (28.3)</td><td align="left">30 (30.3)</td><td align="left">1.25 (0.44–3.49)</td><td></td></tr></tbody></table><table-wrap-foot><p>* Odds ratios derived from univariate logistic regression analysis.</p><p>** P values derived from the Chi-squared test.</p></table-wrap-foot></table-wrap><p>The results of multivariate logistic regression analysis indicated that only the surgical type was significantly associated with seroma formation (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). Of patients with BP, 10 of 43 (23%) developed seroma, while those who underwent MRM 45 of 115 (39%) developed seroma. The seroma formation did not show any significant association with any other variables studied. The results of maultivariate analysis are shown in Table <xref ref-type="table" rid="T2">2</xref>.</p><table-wrap position="float" id="T2"><label>Table 2</label><caption><p>Risk factors for seroma formation derived from the multivariate logistic regression analysis</p></caption><table frame="hsides" rules="groups"><thead><tr><td></td><td align="left"><bold>β (SE)</bold></td><td align="left"><bold>Wald</bold></td><td align="left"><bold>P</bold></td><td align="left"><bold>OR (95% CI)</bold></td></tr></thead><tbody><tr><td align="left"><bold><italic>Age (years)</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left"><40</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">40–49</td><td align="left">0.68 (0.49)</td><td align="left">1.92</td><td align="left">0.16</td><td align="left">1.99 (0.75–5.25)</td></tr><tr><td align="left">>50</td><td align="left">0.75 (0.48)</td><td align="left">2.44</td><td align="left">0.11</td><td align="left">2.12 (0.82–5.44)</td></tr><tr><td align="left"><bold><italic>Tumor size (cm)</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left"><2</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">2–5</td><td align="left">0.38 (0.44)</td><td align="left">0.74</td><td align="left">0.38</td><td align="left">1.46 (0.61–3.49)</td></tr><tr><td align="left">>5</td><td align="left">0.08 (0.52)</td><td align="left">0.03</td><td align="left">0.88</td><td align="left">1.09 (0.39–3.00)</td></tr><tr><td align="left"><bold><italic>Nodal involvement (n = 152)</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">No</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">Yes</td><td align="left">0.35 (0.43)</td><td align="left">0.66</td><td align="left">0.41</td><td align="left">1.42 (0.60–3.35)</td></tr><tr><td align="left"><bold><italic>Surgical procedure</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">Breast conservation</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">Modified radical mastectomy</td><td align="left">1.04 (0.52)</td><td align="left">3.97</td><td align="left">0.04</td><td align="left">2.83 (1.01–7.90)</td></tr><tr><td align="left"><bold><italic>Surgical instrument</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">Scalpel</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">Cautery</td><td align="left">0.60 (0.51)</td><td align="left">1.36</td><td align="left">0.24</td><td align="left">1.83 (0.66–5.07)</td></tr><tr><td align="left"><bold><italic>Neoadjuvant chemotherapy</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">No</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">Yes</td><td align="left">0.33 (0.55)</td><td align="left">0.37</td><td align="left">0.54</td><td align="left">1.40 (0.47–4.13)</td></tr><tr><td align="left"><bold><italic>Pressure garment</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">Yes</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">No</td><td align="left">0.51 90.46)</td><td align="left">1.28</td><td align="left">0.26</td><td align="left">1.67 (0.67–4.11)</td></tr><tr><td align="left"><bold><italic>Axillary drainage time (days/n= 152)</italic></bold></td><td></td><td></td><td></td><td></td></tr><tr><td align="left">>10</td><td align="left">-</td><td align="left">-</td><td></td><td align="left">1.00 (ref.)</td></tr><tr><td align="left">5–10</td><td align="left">0.13 (0.59)</td><td align="left">0.04</td><td align="left">0.76</td><td align="left">1.17 (0.41–3.32)</td></tr><tr><td align="left"><5</td><td align="left">0.16 (0.53)</td><td align="left">0.09</td><td align="left">0.82</td><td align="left">1.14 (0.35–3.66)</td></tr></tbody></table></table-wrap></sec><sec><title>Discussion</title><p>Breast cancer is the most common malignancy in women. Surgery is the mainstay of treatment. Modified radical mastectomy with or without reconstruction or breast preservation in addition to axillary lymph node dissection are common surgical procedures in breast cancer. Surgery of the axilla is associated with numerous complications, including infection, lymphedema of the ipsilateral upper extremity and collection of fluid in surgical site (seroma). Most common complication after breast cancer surgery is wound seroma. The exact etiology of seroma formation remains controversial. Several interventions have been reported with the aim of reducing seroma formation including the use of ultrasound scissors in performing lymphadenectomy [<xref ref-type="bibr" rid="B13">13</xref>], buttress suture [<xref ref-type="bibr" rid="B14">14</xref>], fibrin glue [<xref ref-type="bibr" rid="B15">15</xref>], fibrin sealant [<xref ref-type="bibr" rid="B16">16</xref>], bovine thrombin application [<xref ref-type="bibr" rid="B17">17</xref>], and altering surgical technique to close dead space [<xref ref-type="bibr" rid="B18">18</xref>]. However, it has been suggested that although the use of these interventions might reduce the risk of seroma formation, further studies are needed to verify the real impact on long-term morbidity of such techniques [<xref ref-type="bibr" rid="B19">19</xref>].</p><p>Several studies have been performed to investigate factors related to post-surgical seroma. These studies have observed that the early removal of drains might led to increased incidence of seroma [<xref ref-type="bibr" rid="B12">12</xref>], whereas others have shown that drains removal time had no influence on seroma formation [<xref ref-type="bibr" rid="B3">3</xref>]. The findings from our study also indicated that the length of time drains are left did not influence the seroma rate (Table <xref ref-type="table" rid="T2">2</xref>). Similar observation was reported by a recent study where the use of drains did not prevent seroma formation. On the other hand it was associated with a longer postoperative hospital stay and more pain after surgery for breast cancer [<xref ref-type="bibr" rid="B16">16</xref>]. It has been suggested that the restriction of arm movements may also reduce the incidence of seroma formation [<xref ref-type="bibr" rid="B8">8</xref>]. This observation however was challenged by others who showed that there is no significant disadvantage in early arm motion [<xref ref-type="bibr" rid="B9">9</xref>]. Porter <italic>et al </italic>reported that the use of electrocautery to create skin flaps in mastectomy reduces blood lose but increased the rate of seroma formation [<xref ref-type="bibr" rid="B11">11</xref>]. In addition, an association of postoperative seroma formation with neoadjuvant chemotherapy was also noted [<xref ref-type="bibr" rid="B4">4</xref>]. Compression dressing to prevent seroma rate is a common method used by many surgeons. A study demonstrated that routine use of a pressure garment to reduce postoperative drainage after axillary lymph node dissection for breast cancer is not warranted [<xref ref-type="bibr" rid="B12">12</xref>]. However, we think that the use of pressure garment and prolonged limitation of arm activity not only reduces seroma formation but also may increase the incidence of seroma formation after removal of drain [<xref ref-type="bibr" rid="B12">12</xref>] and even might cause shoulder dysfunction [<xref ref-type="bibr" rid="B8">8</xref>].</p><p>In the present study no relationship was observed between the incidence of seroma and the patients' age, tumor size, and lymph node status. However, the study found that the MRM was associated with higher rate of postoperative seroma formation (OR = 2.83, P = 0.04). Similarly, Gonzalez <italic>et al</italic>, demonstrated that patients who underwent modified radical mastectomy had a greater incidence of seroma formation than patients who underwent breast preservation surgery [<xref ref-type="bibr" rid="B10">10</xref>]. They also showed that there was a direct correlation between age and the development of seroma [<xref ref-type="bibr" rid="B10">10</xref>]. A recent study by Lumachi <italic>et al </italic>indicated that the tumor size and total amount of drainage represented the principal factors of seroma formation following axillary dissection in patients underwent surgery for breast cancer [<xref ref-type="bibr" rid="B19">19</xref>].</p><p>The results of our study suggest that seroma formation after breast cancer surgery is independent of duration of drainage, compression dressing and other known prognostic factors in breast cancer patients except the type of surgery, i.e there is a 2.5 times higher risk of seroma formation in patients undergoing MRM compared to BP. The small sample size of present study is a limitation and hence the power of the study is low. A number of questions remain unanswered and more research is needed to answer these.</p></sec><sec><title>Conflict of interest</title><p>The authors declare that they have no competing interests.</p></sec><sec><title>Source of Funding</title><p>None</p></sec><sec><title>Contributors</title><p><bold>EH </bold>designed the study, collected the data and wrote the first draft of the manuscript.</p><p><bold>AK, MN, ME </bold>and <bold>HH </bold>all contributed to patient recruitment and the preparation of first draft of the manuscript.</p><p><bold>AM </bold>contributed to the study design, data analysis, and edited the final version.</p><p>All authors read and approved of the manuscript.</p></sec></body><back><ref-list><ref id="B1"><citation citation-type="book"><person-group person-group-type="author"><name><surname>Harris</surname><given-names>JR</given-names></name><name><surname>Lippman</surname><given-names>ME</given-names></name><name><surname>Morrow</surname><given-names>M</given-names></name><name><surname>Osborne</surname><given-names>C</given-names></name></person-group><source>Diseases of the breast</source><year>2000</year><edition>2</edition><publisher-name>Philadelphia: Lippincott, Williams and Wilkins</publisher-name></citation></ref><ref id="B2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pogson</surname><given-names>CJ</given-names></name><name><surname>Adwani</surname><given-names>A</given-names></name><name><surname>Ebbs</surname><given-names>SR</given-names></name></person-group><article-title>Seroma following breast cancer surgery</article-title><source>Eur J Surg Oncol</source><year>2003</year><volume>29</volume><fpage>711</fpage><lpage>717</lpage><pub-id pub-id-type="pmid">14602488</pub-id><pub-id pub-id-type="doi">10.1016/S0748-7983(03)00096-9</pub-id></citation></ref><ref id="B3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Barwell</surname><given-names>J</given-names></name><name><surname>Campbell</surname><given-names>L</given-names></name><name><surname>Watkins</surname><given-names>RM</given-names></name><name><surname>Teasdale</surname><given-names>C</given-names></name></person-group><article-title>How long should suction drains stay in after breast surgery with axillary dissection?</article-title><source>Ann R Coll Surg Engl</source><year>1997</year><volume>79</volume><fpage>435</fpage><lpage>437</lpage><pub-id pub-id-type="pmid">9422871</pub-id></citation></ref><ref id="B4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Woodworth</surname><given-names>PA</given-names></name><name><surname>McBoyle</surname><given-names>MF</given-names></name><name><surname>Helmer</surname><given-names>SD</given-names></name><name><surname>Beamer</surname><given-names>RL</given-names></name></person-group><article-title>Seroma formation after breast cancer surgery: incidence and predicting factors</article-title><source>Am Surg</source><year>2000</year><volume>66</volume><fpage>444</fpage><lpage>450</lpage><pub-id pub-id-type="pmid">10824744</pub-id></citation></ref><ref id="B5"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Brayant</surname><given-names>M</given-names></name><name><surname>Baum</surname><given-names>M</given-names></name></person-group><article-title>Postoperative seroma following mastectomy and axillary dissection</article-title><source>Br J Surg</source><year>1987</year><volume>74</volume><fpage>1187</fpage><pub-id pub-id-type="pmid">3427377</pub-id></citation></ref><ref id="B6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Budd</surname><given-names>DC</given-names></name><name><surname>Cochran</surname><given-names>RC</given-names></name><name><surname>Sturtz</surname><given-names>DL</given-names></name><name><surname>Fouty</surname><given-names>WJ</given-names></name></person-group><article-title>Surgical morbidity after mastectomy operations</article-title><source>Am J Surg</source><year>1978</year><volume>135</volume><fpage>218</fpage><lpage>220</lpage><pub-id pub-id-type="pmid">626296</pub-id><pub-id pub-id-type="doi">10.1016/0002-9610(78)90103-4</pub-id></citation></ref><ref id="B7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Aitkin</surname><given-names>DR</given-names></name><name><surname>Minton</surname><given-names>JP</given-names></name></person-group><article-title>Complications associated with mastectomy</article-title><source>Surg Clin North Am</source><year>1983</year><volume>63</volume><fpage>1331</fpage><lpage>1352</lpage><pub-id pub-id-type="pmid">6359504</pub-id></citation></ref><ref id="B8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dawson</surname><given-names>I</given-names></name><name><surname>Stam</surname><given-names>L</given-names></name><name><surname>Heslinga</surname><given-names>JM</given-names></name><name><surname>Kalsbeck</surname><given-names>HL</given-names></name></person-group><article-title>Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective clinical trial</article-title><source>Br J Surg</source><year>1989</year><volume>76</volume><fpage>311</fpage><lpage>312</lpage><pub-id pub-id-type="pmid">2655815</pub-id></citation></ref><ref id="B9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Petrek</surname><given-names>JA</given-names></name><name><surname>Peters</surname><given-names>MM</given-names></name><name><surname>Nori</surname><given-names>S</given-names></name><name><surname>Knaner</surname><given-names>C</given-names></name><name><surname>Kinne</surname><given-names>DW</given-names></name><name><surname>Rogatco</surname><given-names>A</given-names></name></person-group><article-title>Axillary lymphadenectomy: a prospective, randomized trial of thirteen factors influencing drainage, including early or delayed arm mobilization</article-title><source>Arch Surg</source><year>1990</year><volume>125</volume><fpage>378</fpage><lpage>382</lpage><pub-id pub-id-type="pmid">2407228</pub-id></citation></ref><ref id="B10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gonzalez</surname><given-names>EA</given-names></name><name><surname>Saltzstein</surname><given-names>EC</given-names></name><name><surname>Riedner</surname><given-names>CS</given-names></name><name><surname>Nelson</surname><given-names>BK</given-names></name></person-group><article-title>Seroma formation following breast cancer surgery</article-title><source>Breast J</source><year>2003</year><volume>9</volume><fpage>385</fpage><lpage>388</lpage><pub-id pub-id-type="pmid">12968958</pub-id><pub-id pub-id-type="doi">10.1046/j.1524-4741.2003.09504.x</pub-id></citation></ref><ref id="B11"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Porter</surname><given-names>KA</given-names></name><name><surname>O'Connor</surname><given-names>S</given-names></name><name><surname>Rimm</surname><given-names>E</given-names></name><name><surname>Lopez</surname><given-names>M</given-names></name></person-group><article-title>Electrocautery as a factor in seroma formation following mastectomy</article-title><source>Am J Surg</source><year>1998</year><volume>176</volume><fpage>8</fpage><lpage>11</lpage><pub-id pub-id-type="pmid">9683123</pub-id><pub-id pub-id-type="doi">10.1016/S0002-9610(98)00093-2</pub-id></citation></ref><ref id="B12"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>O' Hea</surname><given-names>BJ</given-names></name><name><surname>Ho</surname><given-names>MN</given-names></name><name><surname>Petrek</surname><given-names>JA</given-names></name></person-group><article-title>External compression dressing versus standard dressing after axillary lymphadenectomy</article-title><source>Am J Surg </source><year>1999</year><volume>177</volume><fpage>450</fpage><lpage>453</lpage><pub-id pub-id-type="pmid">10414691</pub-id><pub-id pub-id-type="doi">10.1016/S0002-9610(99)00089-6</pub-id></citation></ref><ref id="B13"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lumachi</surname><given-names>F</given-names></name><name><surname>Burelli</surname><given-names>P</given-names></name><name><surname>Basso</surname><given-names>SM</given-names></name><name><surname>Iacobone</surname><given-names>M</given-names></name><name><surname>Ermani</surname><given-names>M</given-names></name></person-group><article-title>Usefulness of ultrasound scissors in reducing serous drainage after axillary dissection for breast cancer: a prospective randomized clinical study</article-title><source>Am Surg</source><year>2004</year><volume>70</volume><fpage>80</fpage><lpage>84</lpage><pub-id pub-id-type="pmid">14964555</pub-id></citation></ref><ref id="B14"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Schuijtvlot</surname><given-names>M</given-names></name><name><surname>Sahu</surname><given-names>AK</given-names></name><name><surname>Cawthorn</surname><given-names>SJ</given-names></name></person-group><article-title>A prospective audit of the use of a buttress suture to reduce seroma formation following axillary node dissection without drains</article-title><source>Breast</source><year>2002</year><volume>11</volume><fpage>94</fpage><lpage>96</lpage><pub-id pub-id-type="pmid">14965653</pub-id><pub-id pub-id-type="doi">10.1054/brst.2001.0366</pub-id></citation></ref><ref id="B15"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gilly</surname><given-names>FN</given-names></name><name><surname>Francois</surname><given-names>Y</given-names></name><name><surname>Sayag-Beaujard</surname><given-names>AC</given-names></name><name><surname>Glehen</surname><given-names>O</given-names></name><name><surname>Brachet</surname><given-names>A</given-names></name><name><surname>Vignal</surname><given-names>J</given-names></name></person-group><article-title>Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial</article-title><source>Eur Surg Res</source><year>1998</year><volume>30</volume><fpage>439</fpage><lpage>443</lpage><pub-id pub-id-type="pmid">9838238</pub-id><pub-id pub-id-type="doi">10.1159/000008611</pub-id></citation></ref><ref id="B16"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jain</surname><given-names>PK</given-names></name><name><surname>Sowdi</surname><given-names>R</given-names></name><name><surname>Anderson</surname><given-names>AD</given-names></name><name><surname>MacFie</surname><given-names>J</given-names></name></person-group><article-title>Randomized clinical trial investigating the use of drains and fibrin sealent following surgery for breast cancer</article-title><source>Br J Surg</source><year>2004</year><volume>91</volume><fpage>54</fpage><lpage>60</lpage><pub-id pub-id-type="pmid">14716794</pub-id><pub-id pub-id-type="doi">10.1002/bjs.4435</pub-id></citation></ref><ref id="B17"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Burak</surname><given-names>WE</given-names></name><name><surname>Goodman</surname><given-names>PS</given-names></name><name><surname>Young</surname><given-names>DC</given-names></name><name><surname>Farrar</surname><given-names>WB</given-names></name></person-group><article-title>Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin</article-title><source>J Surg Oncol</source><year>1997</year><volume>64</volume><fpage>27</fpage><lpage>31</lpage><pub-id pub-id-type="pmid">9040797</pub-id></citation></ref><ref id="B18"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>McCaul</surname><given-names>JA</given-names></name><name><surname>Aslaam</surname><given-names>A</given-names></name><name><surname>Spooner</surname><given-names>RJ</given-names></name><name><surname>Louden</surname><given-names>I</given-names></name><name><surname>Cavanagh</surname><given-names>T</given-names></name><name><surname>Purushotham</surname><given-names>AD</given-names></name></person-group><article-title>Aetiology of seroma formation in patients undergoing surgery for breast cancer</article-title><source>Breast</source><year>2000</year><volume>9</volume><fpage>144</fpage><lpage>148</lpage><pub-id pub-id-type="pmid">14731838</pub-id><pub-id pub-id-type="doi">10.1054/brst.1999.0126</pub-id></citation></ref><ref id="B19"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lumachi</surname><given-names>F</given-names></name><name><surname>Brandes</surname><given-names>AA</given-names></name><name><surname>Burelli</surname><given-names>P</given-names></name><name><surname>Basso</surname><given-names>SM</given-names></name><name><surname>Iacobone</surname><given-names>M</given-names></name><name><surname>Ermani</surname><given-names>M</given-names></name></person-group><article-title>Seroma prevention following axillary dissection in patients with breast cancer by using ultrasound scissors: a prospective clinical study</article-title><source>Eur J Surg Oncol</source><year>2004</year><volume>30</volume><fpage>526</fpage><lpage>530</lpage><pub-id pub-id-type="pmid">15135481</pub-id><pub-id pub-id-type="doi">10.1016/j.ejso.2004.03.003</pub-id></citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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