A Clinical Study Of Seroma And Lymphedema Follwing Breast Cancer Surgery

Objective:Surgery is a vital piece of comprehensive management of breast cancer. While performing as a means of local therapy, surgery may be accompanied by some adverse consequences. Firstly, it is often accompanied by complications including seroma and upper limb lymphedema. In addition, surgical stress and trauma induces immunosuppression, thus affecting the development of malignant tumor. The aim of this study was to evaluate the effects of various risk factors related to seroma, and to determine if seroma affects lymphedema symptoms. Furthermore, we will evaluate the effect of suturing the anterior edge of latissimus dorsi on reducing seroma formation. In addition, we would explore the prognostic value of drainage volume after breast cancer surgery.Methods:Section I:A retrospective review of518consecutive patients with breast cancer was carried out. Factors taken into consideration including general clinical characteristics, treatment details, indices of hematological examinations, tumor characteristics, and those related to wound drainage output(daily drainage volume and time to drainage volume less than15ml,TTV15).Associations between those potential risk factors and outcome (seroma formation) were investigated. Univariate analyses were performed by chi-square test or Student’s t test or Mann-Whitney test and multivariate analyses by stepwise Logistic regression. Binary regression model was developed. Statistical analysis was performed with Statistical Package for Social Science software (SPSS19.0).Section II:Participants were171breast cancer consecutive patients, Arm1was operated on with a new surgical technique, which is suturing the anterior edge of the latissimus dorsi to the chest wall; Arm2was operated on with the conventional technique. The duration of drainage and incidence of seroma of the two groups were compared with each other. Statistical method was the same as that in the first part.Section III:A retrospective review of503consecutive patients with breast cancer was carried out. Information about general clinical characteristics, treatment details was collected. Relationship between those potential risk factors including seroma formation and the outcome (upper limb lymphedema) were investigated. Statistical method was the same as that in the first part.Section IV:Participants were186breast cancer consecutive patients underwent surgical treatment between1997and2003. Informations about drainage volume and patients’age, lymph node status, tumor characteristics were collected. Survival of patients was based on follow-up informations. Kaplan-Meier analysis was applied to estimate the survival of the groups according to different variables, compared with the log-rank test. Multivariate analyses were conducted with the Cox regression model. The statistical analyses were performed using SPSS version19.0, P<0.05was considered statistically significant.Results:Part I:At the end of the follow-up period, seroma was observed in133cases(25.7%). Univariate analyses revealed that seroma formation was associated with the following factors:red blood cell count. Hemoglobin concentration, age. BMI, combined with diabetes or not, total number of lymph nodes, drainage volume of first three days after surgery and TTV15(P<0.05); Stepwise Logistic regression showed patients’age, total number of lymph nodes and TTV15were independent risk factors for seroma formation.Part II:There was no difference between the patients’ age, tumor size and total number of lymph nodes of the two groups. Number of patients with TTV15≥10days and seroma formation in arm1was significantly less than those of arm2(P<0.05).Part III:At the end of the follow-up period, upper limb lymphedema was observed in186cases(37%). Statistical analyses revealed that seroma and obesity were risk factors for upper limb lymphedema.Part IV:At the end of the follow-up period, recurrence and metastasis was observed in37cases,34patients were dead. Patients with larger tumor, more metastatic lymph nodes, loss of Estrogen Receptor expression and low drainage volume were associated with poorer survival. The COX regression analysis showed that drainage volume and axillary lymph nodes status were independent prognostic factors of patients’survival.Conclusion:Patients’age, total number of lymph nodes and TTV15were independent risk factors for seroma formation. Suturing the anterior edge of latissimus dorsi would reduce seroma formation effectively; Seroma affects the development of upper limb lymphedema; For breast cancer patients, low drainage volume was associated with poorer survival.