Total number of lymph nodes and numer of metastatic lymph nodes harvested during radical mastectomy did not influence early postoperative drainage volume

© P o l s k i e T o w a r z y s t w o G i n e k o l o g i c z n e Nr 08/2013

696

P R A C E O R Y G I N A L N E ginekologia

Ginekol Pol. 2013, 84, 696-699

Total number of lymph nodes and number of metastatic lymph nodes harvested during radical mastectomy did not influence early postoperative drainage volume

Całkowita liczba węzłów chłonnych oraz węzłów przerzutowych

usuniętych podczas radykalnej mastektomii nie wpłynęła na objętość wczesnego drenażu pooperacyjnego

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1 Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Center, Kraków, Poland

2 Department of General Surgery, Ludwik Rydygier Memorial General Hospital, Kraków, Poland

3 Department of Gynaecological Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Center, Kraków, Poland

4 Department of Pathology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Center, Kraków, Poland

5 Liver Transplant Program, Department of Surgery, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiuna, Taiwan

Abstract

Objectives: We aimed at evaluation of the influence of the extent of axillary lymph node dissection, measured by the total number of lymph nodes harvested, on the drainage volume. We also looked at the lymph node positivity (N+) and the number of metastatic axillary lymph nodes as a potential prognostic factors in this regard.

Material and methods: We have analysed the data of 63 patients (F/M: 62/1) with breast cancer, who underwent radical modified mastectomy in 2008-2009 in the single department of surgical oncology.

Results: We observed no significant correlation between the 1) total number of axillary lymph nodes harvested during lymphadenectomy, 2) presence of metastatic lymph nodes (node positive disease), 3) number of metastatic axillary lymph nodes and: drainage volume on the day of surgery, drainage volume on three consecutive postope- rative days and drainage volume from the day of surgery to drain removal.

Conclusion: The extent of axillary lymph node dissection, measured by the total number of lymph nodes excised, did not influence drainage volume after radical modified mastectomy. Neither total number of metastatic lymph nodes excised nor the node positivity (N+) were associated with increased drainage volume after mastectomy with axillary dissection.

Key words:

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Otrzymano: 29.03.2013

Zaakceptowano do druku: 10.06.2013 Corresponding author:

Wojciech M. Wysocki

Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology ul. Garncarska 11, 31-115 Kraków, Poland

tel. +48-12-422-49-28, fax: +48-12-422-66-80 email: z5wysock@cyf-kr.edu.pl

© P o l s k i e T o w a r z y s t w o G i n e k o l o g i c z n e

Nr 08/2013

697

P R A C E O R Y G I N A L N E ginekologia Ginekol Pol. 2013, 84, 696-699

Wojciech M. Wysocki et al. Total number of lymph nodes and number of metastatic lymph nodes harvested during radical mastectomy did not influence early postoperative drainage volume.

Introduction

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Objectives

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Materials and methods Study population

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Statistical analysis

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Results

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Streszczenie

Cel pracy: Celem pracy była ocena zależności pomiędzy całkowitą liczbą węzłów chłonnych wyciętych podczas limfadenektomii pachowej (jako składowej radykalnej mastektomii) a objętością drenażu pooperacyjnego. Ocenio- no także zależność pomiędzy obecnością przerzutów w węzłach chłonnych (cechą N+) oraz liczbą przerzutowych węzłów chłonnych jako potencjalnymi czynnikami wpływającymi na objętość drenażu.

Materiał i metody: Przeanalizowano dane 63 chorych na raka piersi (K/M: 62/1), których w latach 2008-2009 poddano radykalnej zmodyfikowanej mastektomii. Wszystkich chorych operowano w jednym ośrodku.

Wyniki: Nie zaobserwowano znamiennej zależności pomiędzy 1) całkowitą liczbą węzłów chłonnych usuniętych podczas limfadenektomii, 2) obecnością przerzutowych węzłów chłonnych (N+), 3) liczbą przerzutowych węzłów chłonnych a objętością drenażu: w dobie operacji, łącznie w trzech pierwszych dobach po operacji i łącznie do chwili usunięcia drenu.

Wnioski: Zakres usunięcia węzłów chłonnych podczas radykalnej mastektomii, wyrażony poprzez całkowitą liczbę wyciętych węzłów chłonnych, nie wpływał znamiennie na objętość drenażu pooperacyjnego. Nie wykazano także zależności pomiędzy całkowitą liczbą przerzutowych węzłów chłonnych lub obecnością przerzutów w węzłach chłonnych (N+), a zwiększoną objętością pooperacyjnego drenażu.

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© P o l s k i e T o w a r z y s t w o G i n e k o l o g i c z n e Nr 08/2013

698

P R A C E O R Y G I N A L N E

ginekologia Ginekol Pol. 2013, 84, 696-699

Wojciech M. Wysocki et al. Total number of lymph nodes and number of metastatic lymph nodes harvested during radical mastectomy did not influence early postoperative drainage volume.

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Ta b l e I . Clinical and demographic characteristic of the study population.

&OLQLFDOSDUDPHWHUV Mean (range)

Age at operation 61 years (36–83)

Diabetes 8 patients (1)

Neoadiuvant chemotherapy 1 patients (1)

Tumor size 8 cm (–)

Total number of lymph nodes

harvested 17 (6–29)

Total number of metastatic lymph

nodes harvested 27 (–18)

Number of node positive cases (%) 36 patients (71%) 'UDLQDJHYROXPH

day of operation 154 ml (30–400)

1st postoperative day 188 ml (10–350) 2nd postoperative day 195 ml (20–470) 3rd postoperative day 170 ml (0–400) 4th postoperative day 167 ml (35–400) 5th postoperative day 145 ml (0-290) 6th postoperative day 154 ml (100–280) 7th postoperative day 148 ml (50–250) 8th postoperative day 85 ml (50–120)

© P o l s k i e T o w a r z y s t w o G i n e k o l o g i c z n e

Nr 08/2013

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P R A C E O R Y G I N A L N E ginekologia Ginekol Pol. 2013, 84, 696-699

Wojciech M. Wysocki et al. Total number of lymph nodes and number of metastatic lymph nodes harvested during radical mastectomy did not influence early postoperative drainage volume.

R e f e r e n c e s

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3. He XD, Guo ZH, Tian JH, [et al.]. Whether drainage should be used after surgery for breast cancer? A systematic review of randomized controlled trials. Med Oncol. 2011, 28, Suppl 1, 22-30.

4. Ackroyd R, Reed W. A prospective randomized trial of the management of suction drains following breast cancer surgery with axillary clearance. Breast. 1997, 6, 271-274.

5. Kuroi K, Shimozuma K, Taguchi T, [et al.]. Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol. 2006, 36, 197-206.

6. Wysocki W, Burzyński T, Mituś J. Wpływ wybranych czynników klinicznych na objętość drenażu po radykalnej mastektomii. Nowotwory. 2011, 61, 130-133.

7. Pogson C, Adwani A, Ebbs S. Seroma following breast cancer surgery. Eur J Surg Oncol. 2003, 29, 711-717.

8. Taylor J, Rai S, Hoar F, [et al.]. Breast cancer surgery without suction drainage: The impact of adopting a ‘no drains’ policy on symptomatic seroma formation rates. Eur J Surg Oncol. 2013, 39, 334-338.

9. Banerjee D, Williams E, Ilott J, [et al.]. Obesity predisposes to increased drainage following axillary node clearance: a prospective audit. Ann R Coll Surg Engl. 2001, 83, 268-271.

10. Loo W, Chow L. Factors predicting seroma formation after mastectomy for Chinese breast cancer patients. Indian J Cancer. 2007, 44, 99-103.

11. Christodoulakis M, Sanidas E, de Bree E, [et al.]. Axillary lymphadenectomy for breast cancer - the influence of shoulder mobilisation on lymphatic drainage. Eur J Surg Oncol. 2003, 29, 303-305.

12. Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumors. 7th ed.

Oxford: Wiley-Blackwell, 2010.

13. Purushotham A, Bennett Britton T, Klevesath M, [et al.]. Lymph node status and breast cancer- related lymphedema. Ann Surg. 2007, 246, 42-45.

International Society of Ultrasound in Obsterics & Gynecology

Ultrasound Section of Polish Society of Gynecology

––––––––––––––––––––––––––––

International Society of Ultrasound in Obsterics & Gynecology – ISUOG

o r a z

Sekcja USG PTG

zapraszają

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06-07.09.2013

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Fetal malformation

prezentacja przypadków live, tłumaczenia symultamiczne

––––––––––––––––––––––––––––

W y k ł a d ow c y :

Członkowie ISUOG za całej Europy

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Marek Dubiel (ISUOG – Polska) Marek Pietryga (ISUOG – Polska)

M i e j s c e o b ra d :

Toruń

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Uczstnicy Kursu otrzymają certyfikat uczestnictwa

International Society of Ultrasound in Obsterics & Gynecology – ISUOG

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30 punktów edukacyjnych USG PTG

K O M U N I K AT