乳がん：現在の研究

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Post-mastectomy seroma: Does Dead Space Obliteration Have a Protective Effect?

Murad A Jabir, Abdallah Taha, Mahmoud R Shehata, Mostafa M Sayed and Amer Yehia

Background: Seroma formation after breast surgery could result in significant morbidity and subsequent delay to commence the adjuvant therapy. A prospective randomized study was done to assess the effect of obliterating the axillary dead space by sutures with Flap fixation after Breast cancer surgery either by Modified Radical Mastectomy (MRM) or Conservative Breast Surgery (CBS) prospectively. In addition, Factors predicting the formation of seroma were analyzed and reported.

Methods: A total of 164 patients diagnosed as Breast cancer, they were randomized to have the post mastectomy dead space obliterated (intervention group) or standard wound closure (control group) following either MRM or CBS. Those had immediate reconstruction were excluded from the study. Drains were routinely left in place until the preceding 48-hour output was < 30 milliliters/day. The duration of the drains left in place and the incidence of seroma formation were reported. A multivariate analysis for the potential factors associated with seroma formation was done.

Results: Fifty-eight (n=58) patients were assigned to the treatment group and 106 (n=106) to the control group. MRM was performed on 105 patients (64%) and CBS on 59 (36%). Ten of the 58 patients (17.2%) in the intervention group developed a seroma in comparison to 33 of the 106 control patients (31.1%) (P=0.03). There was a significant reduction in the duration of suction drain in situ with obliteration of the dead space (P=0.001). No statistically significant differences were observed between intervention and control groups with respect to patient and pathological parameters or the incidence of other wound complications. Multivariate analysis revealed that Significant risk factors for seroma formation were Diabetes Mellitus (DM) (P=0.01), neoadjuvant CTH (P=0.019), number of retrieved L node (P=0.019), and dead space obliteration (P=0.04).

Conclusion: On multivariate analysis, the most significant factors affecting seroma formation were DM, neoadjuvant CTH, number of retrieved L node and Dead Space Obliteration. Dead Space Obliteration following breast cancer surgery is a simple technique that reduces the time of suction tubal drainage, and incidence of seroma formation.