COMPLICATIONS AFTER SURGERY FOR INVASIVE BREAST CANCER: COHORT STUDY
Keywords:Breast cancer, Breast surgery, Complications
Mastectomy or wide local excision, and axillary clearance remain standard management option for majority of patients with breast cancer.
The aim of this study is to evaluate the frequency and pattern of complications following breast cancer surgery in our practice with comparison to results of international publications.
Materials and Methods
This retrospective descriptive study included 90 patients who underwent Modified Radical Mastectomy (MRM), Wide Local Excision (WLE), or Sentinel Lymph Node biopsy (SLN) at Sulaimani city by the author, which were eligible according to inclusion criteria. The interviews were conducted to collect data and record the information on the structured proforma questionnaire. Some information was extracted from patients’ medical records in the hospitals
Out of 90 patients, 63 (70%) of patients had seroma formation, 21 (23.2%) of them had lymphoedema, 16 (17.8%) of them were suffered from early or delayed upper arm pain, and in 4 (4.4%) of them wound infection was noticed.
Seroma is the most common complication of surgery for breast cancer whereas, lymphoedema is the second most common, followed by upper arm pain, and then wound infection.
Jan WA, Haq MI, Haq MA, Khan AS. Early complications of Modified Radical Mastectomy. JPMI. 2006; 20(3): 248-251.
Mayacock LA, Dillon P, Dixon JM. Morbidity related to intercostobrachial nerve damage following axillary surgery for breast cancer. The Breast. 1998; 7:209-212.
Ball AB, Waters R, Fish S, Thomas JM. Radical axillary dissection in the staging and treatment of breast cancer. Annals of the Royal College of England. 1992; 74:126-129.
Odwyer PJ. Axillary dissection in primary breast cancer. BMJ. 1991; 302:360-361.
Funnel I, Crowe PJ, Dent DM. Does surgical experience influence mastectomy complications. Annals of the Royal College of Surgeons of England. 1992; 74:178-180.
Khan F, Shaikh FM, Keane R. Complex Regional Pain Syndrome Type I as a Complication of Axillary Clearance. Journal of Pain and Symptom Management. 2006; 31(6):481-482.
Theunissen D, Cant PJ, Dent DM. Factors that influence volume and duration of wound drainage after mastectomy and level III axillary node clearance. The Breast. 2001; 10:538-539.
Iovino F, PioAuriemma P, Ferraraccio F, Antoniol G, Barbarisi A. Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial. The American Journal of Surgery. 2012; 203: 708-714.
Ivens D, Hoe AL, Podd TJ, Hamilton CR, Taylor I, Royle GT. Assessment of morbidity from complete axillary dissection. Br. J. Cancer. 1992; 66:136-138.
Poole K, Fallowfield LJ. The psychological impact of post-operative arm morbidity following axillary surgery for breast cancer: a critical review. The Breast. 2002; 11:81-87.
Srivastava V, Basu S, Shukla VK. Seroma Formation after Breast Cancer Surgery: What We Have Learened in the Last Two Decades. J Breast Cancer. 2012; 15(4):373-380.
Sampathraju S, Rodrigues G. Seroma Formation after Mastectomy: Pathogenesis and Prevention. Indian J Surg Oncol. 2010; 1(4):328-333.
DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systemic review and meta-analysis. Lancet Oncol. 2013; 14:500-15.
Gennaro M, Maccauro M, Sigari C, Casalini P, Bedodi L, Conti AR, et al. Selective axillary dissection after axillary reverse mapping to prevent breast cancer-related lymphoedema. EJSO. 2013; 39: 1341-1345.
Bains SK, Stanton AWB, Cintolesi V, Ballinger J, Allen S, Zammit C, et al. A constitutional predisposition to breast cancer-related lymphoedema and effect of axillary lymph node surgery on forearm muscle lymph flow. The Breast. 2015; 24: 68-74.
Salmon RJ, Ansquer Y, Asseain B. Preservation versus section of intercostals-brachial nerve in axillary dissection for breast cancer- a prospective randomized trial. European Journal of Surgical Oncology. 1998; 24:158-161.
Ahmed A, Sadadcharam G, Huisama F, Fogarty K, Mushtaque M , Shafiq A, et al. Postoperative Complications following Nodal Dissection and Their Association with Melanoma Recurrence. Hindawi Publishing Corporation. 2013; 10:1-6.
Wilke LG, McCall LM, Posther KE, Whitworth PW, Reintgen DC, Leitch AM, et al. Surgical Complications Associated With Sentinel Lymph Node Biopsy: Results From a Prospective International Cooperative Group Trial. Annals of Surgical Oncology. 2006; 13(4):491-500.
Rovere GQ, Daniels I, Ahmad I. Complications after level I, II axillary dissection without division of pectoralis minor. Breast Cancer early disease. 1999; 5: 211.
Nevola Teixeira LF, Veronesi P, Lohsiriwat V, Luini A, Schorr MC, Garusi C, et al. Axillary web syndrome self-assessment questionnaire: Initial development and validation. The Breast. 2014; 23: 836-843.
Van Bemmel AJM, Van de Velde CJH, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: A systemic review. EJSO. 2011; 37:829-835.
Gong Y, Xu J, Shao J, Cheng H, Wu X, Zhao D, et al. Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial. The American Journal of Surgery. 2010; 200: 352-356.
Keogh GW, Doughty JC, McArdle CSM, Kooke TG. Seroma formation related to electrocautery in breast surgery: a prospective randomized trial. The Breast. 1998; 7:39-41.
Soon PSH, Clark J, Magarey CJ. Seroma formation after axillary lymphadenectomy with and without the use of drains. The Breast. 2005; 14: 103-107.
Tjalma WAA. Suction drain-induced haemorrhage after nerve-and vessel-sparing axillary lymph node dissection for breast cancer. The Breast. 2006; 15: 442-444.
Rovere GQ, Ahmad I, Singh P, Ashley S, Daneils IR, Mortimer P. An audit of the incidence of arm lymphoedema after prophylactic level I/II axillary dissection without division of the pectolaris minor muscle. Ann R Coll Surg Engl. 2003; 85:158-161.
Mathew J, Barthelmes L, Neminathan S, Crawford D. Comparative Study of lymphoedema with axillary node dissection versus axillary node sampling with radiotherapy in patients undergoing breast conservation surgery. EJSO. 2006; 32:729-732.
Kok MD, Weijden TV, Voogd AC, Dirksen CD, Van De Velde CJ, Roukema JA, et al. Implementation of a short stay program after breast cancer surgery. British Journal of Surgery. 2010; 97: 189-194.
Marla S, McMillan DC, Stallard S. Factors influencing postoperative length of hospital stay after breast cancer surgery. The Breast. 2013; 22(3):289-294.
Dawning A, Lansdown M, West RM, Thomas JD, Laurence G, Forman D. Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based study. BMC Health Services Research. 2009; 9: 202.
Bianco PD, Zavagno G, Burelli P, Scalco G, Barutta L, Carraro P, et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lynph node dissection for breast cancer patients: Results of the sentinella-GIVOM Italian randomized clinical trial. EJSO. 2008; 34: 508-513.
Troost MS, Kempees CJ, De Roos MA. Breast cancer surgery without drains: No influence on seroma formation. International Journal of Surgery. 2015; 13:170-174.
Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, et al. Surgical Complications Associated With Sentinel Lymph Node Dissection Plus Axillary Lymph Node Dissection compared With SLND Alone in the American College of surgeons Oncology group Trial Z0011. Journal of Clinical Oncology. 2007; 25: 3657-3663.
Barwell J, Campbell L, Watkins RM, Teasedale C. How long should suction drains stay in after breast surgery with axillary dissection? Ann R Coll Surg Engl. 1997; 79:435-437.
Vitug AF, Newman LA. Complications in breast surgery. Surg Clin N Am. 2007; 87:431-451.
Copyright (c) 2016 Hawar Hasan Ali Ghalib
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.