Tachosil^® to reduce the morbidity of axillary lymph node dissection in breast cancer

Background

Seroma formation after axillary lymph node dissection in breast cancer remains a problem despite many efforts to reduce surgery-related morbidity. The aim of the present study was to evaluate the impact of a fibrin-glue-coated collagen patch (Tachosil^®; Nycomed Laboratory, Denmark) to reduce the volume and duration of postoperative axillary drainage, the duration of hospital stay, and procedural safety.

Patients and methods

Twenty-five patients with breast cancer were included in this prospective study. All patients underwent breast surgery including lumpectomy or mastectomy followed by axillary lymph node dissection (Berg Level I and II). In 13 patients, a surgical haemostasis sponge Tachosil^® was applied from the apex axillae to the thoracic longus nerve and 12 had standard closure of the axillary lymphadenectomy area. Patients did not differ with respect to general characteristics, such as age, body mass index, treatment modality, and tumor stage distribution. There were six mastectomy and five lumpectomy operations in the Tachosil^® group, and seven mastectomy and four lumpectomy surgeries in the control group. The mean number of removed lymph nodes was 11.9 in the Tachosil^® group with a mean of 1.2 metastatics nodes, and was 12.2 in the control group with a mean of 2.5 metastatic nodes.

Results

The mean duration of axillary drainage was 3.3 days in the Tachosil^® group and 5.5 days in the control group. The mean total drainage volume was 246 ml in the Tachosil^® group and 470 ml in the standard closure group. The mean length of postoperative hospital stay was 3.5 days in the Tachosil^® group and 5.5 days in the standard closure group. Seroma formation after drain removal was found in four patients with a mean of drainage volume of 161 ml in the Tachosil^® group, and in five patients with a mean of drainage volume of 517 ml in the standard closure group. No intolerance of the product was described.

Conclusion

The use of Tachosil^® in the axillary area in patients with breast cancer requiring axillary dissection seems to reduce the volume and duration of postoperative axillary drainage, the duration of hospital stay, and the frequency and volume of seroma after axillary drainage. Larger series are required to confirm these results.