A Prospective Study of the Efficacy of Endofascial Axillary Dissection to Reduce Axillary Seroma Formation

Abstract

Introduction Seroma formation is a common complication following axillary dissection. The pathogenesis of seroma is poorly understood. Various chemical and mechanical methods have been tried to reduce seroma with varying results. In this study, we look at a novel method of axillary dissection to reduce seroma and its attendant morbidity. The objective of the study is to compare endofascial axillary lymphadenectomy with routine axillary lymphadenectomy regarding axillary drain output following breast conservation surgery.

Methods We did a prospective interventional study of endofascial axillary dissection in patients undergoing breast conservation surgery. Comparison was done with historical controls who underwent breast conservation surgery with routine axillary lymphadenectomy before the study period. All patients were operated by the same surgeon.

Results Breast conservation surgery with endofascial axillary dissection was performed in 36 patients and compared with 36 patients who underwent routine axillary dissection before the study period. The mean total axillary drain output in the endofascial and routine groups were 796.8 and 1,259.3 mL, respectively (p = 0.001). The average day of drain removal in the endofascial and routine groups were 10.8 and 14.9 days, respectively (p = 0.001). The nodal yield of the endofascial and routine groups were 15.3 and 16.4 nodes, respectively (p = 0.449). The duration of surgery of the endofascial and routine groups were 89.3 and 85.1 minutes, respectively (p = 0.366).

Conclusion Endofascial axillary dissection significantly reduced the mean total axillary drain output and resulted in early drain removal compared with routine axillary dissection. There were no significant differences in the nodal yield, operative time, seroma aspirations, and wound complications between the endofascial and routine axillary dissection groups.