Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis

Abstract

Seroma or lymphocele remains the most common complication after mastectomy and lymphadenectomy for breast cancer. Many different techniques are available to prevent this complication: wound drainage, reduction of the dead space by flap fixation, use of various types of energy, external compression dressings, shoulder immobilization or physical activity, as well as numerous drugs and glues. We searched MEDLINE, clinicaltrials.gov, Cochrane Library, and Web of Science databases for publications addressing the issue of prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy. Quality was assessed using Hawker's quality assessment tool. Incidence of seroma or lymphocele were collected. Fifteen randomized controlled trials including a total of 1766 patients undergoing radical mastectomy and axillary lymphadenectomy for breast cancer were retrieved. The incidence of lymphocele or seroma in the study population was 24.2% (411/1698): 25.2% (232/920) in the test groups and 23.0% (179/778) in the control groups. Neither modification of surgical technique (RR 0.86; 95% CI [0.72, 1.03]) nor application of a medical treatment (RR 0.96; 95% CI [0.72, 1.29]) was effective in preventing lymphocele. On the contrary, decreasing the drainage time increased the risk of lymphocele (RR 1.88; 95% CI [1.43, 2.48). There was no publication bias but the studies were of medium to low quality. To conclude, despite the heterogeneity of study designs, drainage appears to be the most effective technique, although the overall quality of the data is low.

Figure 1

Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram of literature screening and selection.

Figure 2

Forest plot for seroma incidence following application of a treatment designed to prevent lymphocele after mastectomy with axillary lymphadenectomy. Risk ratios are shown with 95% confidence intervals.

Figure 3

Forest plot for seroma incidence following application of a medical treatment designed to preventing lymphocele after mastectomy with axillary lymphadenectomy. Risk ratios are shown with 95% confidence intervals.

Figure 4

Forest plot for seroma incidence following application of a surgical technique designed to prevent lymphocele after mastectomy with axillary lymphadenectomy. Risk ratios are shown with 95% confidence intervals.

Figure 5

Forest plot for seroma incidence following application of a modified drainage method designed to prevent lymphocele after mastectomy with axillary lymphadenectomy. Risk ratios are shown with 95% confidence intervals.