Axillary lymphadenectomy for breast cancer without axillary drainage.

OBJECTIVE

To evaluate axillary lymph node dissection done without closed drainage in conjunction with breast conservation cancer surgery.

DESIGN

Prospective clinical study.

SETTING

Two university hospitals.

PATIENTS

Eighty-one women undergoing wide local excision of breast cancer with simultaneous or subsequent axillary lymph node dissection.

INTERVENTIONS

No axillary drain was placed following axillary lymphadenectomy.

MAIN OUTCOME MEASURES

The development and resorption of axillary seroma fluid as measured by clinical aspiration and serial sonographic examination.

RESULTS

Thirty-four (42%) of the 81 women required axillary seroma aspiration even though axillary fluid was present in 92% (22/24) of those studied sonographically. The seromas accumulated over the first 2 weeks following axillary dissection and resorbed over the next 2 weeks, as assessed by both clinical and sonographic examination. The complication rate was 2% (2/81). The surgery was performed safely on an outpatient or short-stay basis in 99% (80/81) of patients. All patients except one were discharged within 23 hours of surgery, and 56 patients were discharged directly after anesthesia.

CONCLUSION

Axillary lymph node dissection done in conjunction with breast conservation surgery can be performed in an ambulatory or short-stay setting without axillary drainage. Postoperative seromas will resolve within 1 month, and fewer than half will require aspiration. Lymphadenectomy without drainage reduces morbidity and allows the patient greater personal comfort.