Whether Drainage Should Be Used After Surgery For Breast Cancer? A Systematic Review Of Randomized Controlled Trials

Objective:A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether patients benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer surgery.Methods:RCTs of drainage versus no drainage after ALND in females with breast cancer were retrieved from the following bibliographic database:the Cochrane Library, PubMed, EMBASE, ISI Web of Knowledge, Chinese Biomedical Retrieval System, VIP Chinese Periodical Database and so on. In addition, the reference lists of all related articles of this paper were hand searched. Two authors independently assessed trials quality based on a modified Jadad scale and extracted data. RevMan5.1.6software was used to pool studies if it is appropriate and valuble. Odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were presented with95%confidence intervals (CI).Results:Six RCTs to compare drainage with no drainage after ALND in breast cancer surgery were included in the systematic review and total585patients were pathological diagnosis of breast cancer in women before surgery. Overall, all trials were high quality according to modified Jadad score. The study demonstrated that insertion of a drain after breast cancer surgery resulted in a statistically significant reduction in the rate of seroma (OR=0.36,95%CI0.16to0.81, p=0.01), the volume of aspiration (MD=-100.10,95%CI-174.36to-25.85, P=0.008), or the frequency of seroma aspiration (MD=-1.03,95%CI-1.35to-0.71, P<0.00001), but prolonged the length of postoperative hospital stay (MD=1.52,95%CI,0.36to2.68, P=0.01). There was no statistically significant difference in the incidence of wound infection (OR=0.69,95%CI0.36to1.34, P-0.28) between drainage group and no drainage group. The study that according to Meta-analyses showed:there was no statistically significant difference in the incidence of wound infection (OR=0.69,95%CI0.36to1.34, P=0.28)between drainage group and no drainage group, but significant differences were found between the two groups in the rate of seroma (OR=0.36,95%CI0.16to0.81, p=0.01), the volume of aspiration (MD=-100.10,95%CI-174.36to-25.85, P=0.008), the frequency of seroma aspiration (MD=-1.03,95%CI -1.35to-0.71, P<0.00001), the length of postoperative hospital stay (MD=1.52,95%CL,0.36to2.68,P=0.01).Conclusion:Based on the current evidence, insertion of a drain following ALND in breast cancer surgery effectively decreased seroma formation, volume of aspiration as well as frequency of seroma aspiration without increasing the incidence of wound infection, but extending their postoperative stay in hospital.