Impact of microporous polysaccharide haemostatic agent on patients undergoing mastectomy or axillary dissection on seroma formation and timing of drain removal

Authors

  • Sarah Mahmood Department of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia
  • Alen Maximillian Brodaric Department of Surgery, Tamworth Rural Referral Hospital, North Tamworth, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
  • Rajkumar Srinivasan Department of Surgery, Tamworth Rural Referral Hospital, North Tamworth, NSW, Australia
  • Ruben Cohen-Hallaleh Department of General Surgery, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20240674

Keywords:

Breast seroma, Mastectomy, ARISTA, ALND

Abstract

Background: Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTATM AH has been designed to prevent postoperative seromas formation in vitro.

Methods: We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal.

Results: A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTATM AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTATM AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002).

Conclusions: There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTATM AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram, I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. 2021;711(3):209-49.

Retief FP, Cilliers L. Breast cancer in antiquity. SAfr Med J. 2011;101:513-5.

Plesca M, Bordea C, El Houcheimi B, Ichim E, Blidaru A. Evolution of radical mastectomy for breast cancer. J Med Life. 2016;9(2):183-6.

Capella-Monsonís H, Shridhar A, Chirravuri B, Figucia M, Learn G, Greenawalt K, et al. A Comparative Study of the Resorption and Immune Response for Two Starch-Based Hemostat Powders. J Surgical Res. 2023;282:210-24.

Falcone V, Krotka P, Deutschmann C, Danzinger S, Reischer T, Pfeiler G, et al. Use of polysaccharide hemostatic agent (HaemoCer™) in breast cancer surgery to reduce postoperative complications: A randomised controlled trial. Int Wound J. 2023;20(4):925-34.

Faisal M, Salem S, Kamel N, Abd-Elzaher H, Bakr AA, Fathy H. Effect of autologous fibrin glue on seroma reduction after modified radical mastectomy for breast cancer: A randomized controlled trial. Ann Med Surg (Lond). 2021;63:102135.

Calpin GG, McAnena PF, Davey MG, Calpin P, Kerin MJ, McInerney N, et al. The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: A meta-analysis. Surgeon. 2023;21(4):e183-94.

Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76(12):1088-95.

Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Evidence Based Risk Factors for Seroma Formation in Breast Surgery. Jap J Clin Oncol. 2006;36(4):197-206.

Isozaki H, Yamamoto Y, Murakami S, Matsumoto S, Takama T. Impact of the surgical modality for axillary lymph node dissection on postoperative drainage and seroma formation after total mastectomy. Patient Safety Surg. 2019;13(1):20.

Thorarinsson A, Fröjd V, Kölby L, Modin A, Lewin R, Elander A, et al. Blood loss and duration of surgery are independent risk factors for complications after breast reconstruction. J Plast Surg Hand Surg. 2017;51(5):352-7.

Sandhu HSMO, Komorowska-Timek ED. Lymphatic contribution in a chronic breast seroma: a case report. Ann Breast Surg. 2021;5:40.

Gambardella C, Clarizia G, Patrone R, Offi C, Mauriello C, Romano 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(1):125.

Ali A, Ozturk C, Magner WJ, Sheedy B, Sigurdson SL. Seroma after Breast Reconstruction with Tissue Expanders: Management and Outcomes. Plastic Surg Conference. 2020;91(3):331-6.

Marangi GF, Segreto F, Morelli Coppola M, Arcari L, Gratteri M, Persichetti P. Management of chronic seromas: A novel surgical approach with the use of vacuum assisted closure therapy. Int Wound J. 2020;17(5):1153-8.

Liechti R, van de Wall BJM, Hug U, Fritsche E, Franchi A. Tranexamic Acid Use in Breast Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2023;151(5):949-57.

Van Zeelst LJ, Ten Wolde B, Van Eekeren R, Volders JH, De Wilt JHW, Strobbe LJA. Quilting following mastectomy reduces seroma, associated complications and health care consumption without impairing patient comfort. J Surg Oncol. 2022;125(3):369-76.

Faisal M, Fathy H, Shaban H, Abuelela ST, Marie A, Khaled I. A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial. Patient Safety Surg. 2018;12(1):8.

Ridings P, Bailey C, Bucknall TE. Argon beam coagulation as an adjunct in breast-conserving surgery. Ann R Coll Surg Engl. 1998;80(1):61-2.

Suarez-Kelly LP, Pasley WH, Clayton EJ, Povoski SP, Carson WE, Rudolph R. Effect of topical microporous polysaccharide hemospheres on the duration and amount of fluid drainage following mastectomy: a prospective randomized clinical trial. BMC Cancer. 2019;19(1):99.

Bruckner BA, Blau LN, Rodriguez L, Suarez EE, Ngo UQ, Reardon MJ, et al. Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures. J Cardiothorac Surg. 2014;9:134.

Highland N. Seroma drainage following breast surgery. NHS Highland. 2021;15(4):373-80.

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Published

2024-03-11

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Original Research Articles