Authors
Bagateliya Z.A.1, 3, Titov K.S.1, 2, Talybova N.R.3, Lebedinskiy I.N.1, Karseladze D.A.1, Kuts I.N.1, Lebedev S.S.1, 3
1 Moscow Multidisciplinary Scientific and Clinical Center named after S.P. Botkin, Moscow
2 Peoples’ Friendship University of Russia, Moscow
3 Russian Medical Academy of Continuous Professional Education, Moscow
Abstract
Backround. Breast cancer (BC) remains the leading oncological disease among women worldwide and in Russian, as well. In early-stage breast cancer (T1–3N0M0), sentinel lymph node biopsy (SLNB) is a mandatory diagnostic procedure for accurate surgical staging. However, SLNB may result in lymphorrhea, formation of lymphoceles, and, more rarely, upper limb lymphedema, which are among the most common complications of surgical treatment of breast cancer. According to various authors, postoperative lymphorrhea after SLNB occurs in 5–93% of cases as a result of impaired lymph transport through the lymphatic vessels. The main clinical problem of this condition is associated with uncontrolled and unpredictable lymphatic flow in the axillary region, arising during interventions in the regional lymphatic drainage area. To date, there is no unified approach to the effective prevention and treatment of postoperative lymphorrhea. Thus, preventive measures aimed to reduce postoperative lymphorrhea in patients with early-stage breast cancer remain an unresolved issue in oncologic surgery and research in this area is highly relevant.
Aim. To develop and comparatively evaluate the effectiveness of an intraoperative lipofilling technique and its combination with latex tissue glue for the prevention of lymphorrhea in patients with early-stage breast cancer after lumpectomies and sentinel lymph node biopsy.
Materials and methods. This single-center prospective randomized controlled study included 120 patients with early-stage breast cancer. Between September 1, 2024, and March 31, 2025, all patients underwent lumpectomy with sentinel lymph node biopsy. Patients were allocated into three groups: Group A included 40 patients who underwent layered wound closure in the axillary region; Group B included 42 patients who received autologous fat transplantation into the axillary region; Group C (control group) consisted of 38 patients who underwent autologous fat transplantation combined with the application of latex tissue to the wound surface. In the postoperative period, ultrasound examination of the axillary soft tissues was performed to assess the presence of fluid.
Results. A statistically significant difference in the number of aspiration procedures was observed when comparing two study groups with the control group (RR = 5.26; 95% CI 1.23–22.48; p = 0.012 and RR = 3.68; 95% CI 1.09–12.40; p = 0.032, respectively). In the control group, the risk of aspiration puncture was more than five times higher compared with Group A (RR = 5.26).
Discussion. The study demonstrated high effectiveness of lipofilling, both as a standalone technique and in combination with a latex tissue glue, in the prevention of postoperative lymphorrhea.
Keywords: breast cancer, sentinel lymph node biopsy, lymphorrhea, lipofilling, latex tissue glue.
References
1. Sakorafas GH. Breast cancer surgery--historical evolution, current status and future perspectives. Acta Oncol. 2001; 40(1): 5-18. doi: 10.1080/ 028418601750070984.
2. Sakorafas GH, Safioleas M. Breast cancer surgery: an historical narrative. Part III. From the sunset of the 19th to the dawn of the 21st century. Eur J Cancer Care (Engl). 2010; 19(2): 145-166. doi: 10.1111/j.1365-2354. 2008.01061.x.
3. Sakorafas GH, Peros G. Sentinel lymph node biopsy in breast cancer: what a physician should know, a decade after its introduction in clinical practice. Eur J Cancer Care (Engl). 2007; 16(4): 318-321. doi: 10.1111/j. 1365-2354.2006.00762.x.
4. Thomson DR, Sadideen H, Furniss D. Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database of Systematic Reviews. 2013; 10.
5. Adrien C, Katia M, Marie-Lucile B, Alice R, et al. Prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy for breast cancer: systematic review and meta-analysis. Sci Rep. 2022; 12(1): 10016. doi: 10.1038/s41598-022-13831-9.
6. Akrida I, Michalopoulos NV, Lagadinou M, PapadoliopoulouM, et al. An Updated Review on the Emerging Role of Indocyanine Green (ICG) as a Sentinel Lymph Node Tracer in Breast Cancer. Cancers (Basel). 2023; 15(24): 5755. doi: 10.3390/cancers15245755.
7. Ermoshchenkova MV. Profilaktika limforei posle radikalnykh mastektomiy s ispolzovaniem khirurgicheskikh metodik i plazmennoy koagulyatsii. [dissertation]. M., 2007. 168 s. (In Russ.)
8. Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006; 76(12): 1088-95. doi: 10.1111/j.1445-2197.2006.03949.x.
9. Burckhardt CS, Jones KD. Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery. Health Qual Life Outcomes. 2005; 3: 30. doi: 10.1186/1477-7525-3-30.
10. Thalji SZ, Cortina CS, Guo MS, Kong AL. Postoperative Complications from Breast and Axillary Surgery. Surg Clin North Am. 2023; 103(1): 121-139. doi: 10.1016/j.suc.2022.08.007.
11. Al-Hilli Z, Wilkerson A. Breast Surgery: Management of Postoperative Complications Following Operations for Breast Cancer. Surg Clin North Am. 2021; 101(5): 845-863. doi: 10.1016/j.suc.2021.06.014.
12. Kozlovskaya NA, Artemova NA, Krasnyy SA. Khirurgicheskoye lecheniye postmastektomicheskoy limfedemy. Meditsinskiye novosti. 2020; 11(314). (In Russ.)
13. Lyubota RV, Anikus’ko NF, Zotov AS, Vereshchako RI, Lyubota II. Lipofiling kak metod rekonstruktivno-vosstanovitel’nogo lecheniya bol’nykh rakom molochnoy zhelezy (obzor literatury). Opukholi zhenskoy reproduktivnoy sistemy. 2014; 4. (In Russ.)
14. Tayeh S, Muktar S, Wazir U, et al. Is Autologous Fat Grafting an Oncologically Safe Procedure following Breast Conserving Surgery for Breast Cancer? A Comprehensive Review. J Invest Surg. 2022; 35(2): 390-399. doi: 10.1080/08941939.2020.1852343.
15. Vyas KS, DeCoster RC, Burns JC, et al. Autologous Fat Grafting Does Not Increase Risk of Oncologic Recurrence in the Reconstructed Breast. Ann Plast Surg. 2020; 84(6S Suppl 5): S405-S410. doi: 10.1097/SAP.0000000000002285.
16. Khanevich MD. Primeneniye kleyevykh kompozitsiy v khirurgii. Pyatiminutka. 2007; 1: 18-23. (In Russ.)
17. Kull S, Martinelli I, Briganti E, et al. Glubran2 surgical glue: in vitro evaluation of adhesive and mechanical properties. J Surg Res. 2009; 157(1): e15-e21. doi: 10.1016/j.jss.2009.01.034.
18. Bhalla RK, Lesser TH. Simple, painless, cosmetic closure of endaural incisions. J Laryngol Otol. 2003; 117(1): 67-68. doi: 10.1258/002221503321046685.
19. Trott AT. Cyanoacrylate tissue adhesives. An advance in wound care. JAMA. 1997; 277(19): 1559-1560. doi: 10.1001/jama.277.19.1559.
20. Hallock GG. Expanded applications for octyl-2-cyanoacrylate as a tissue adhesive. Ann Plast Surg. 2001; 46(2): 185-189. doi: 10.1097/ 00000637-200102000-00020.
21. Thomson DR, Sadideen H, Furniss D. Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev. 2013; 2013(10): CD006823. doi: 10.1002/14651858.
22. van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surg Oncol. 2011; 37(10): 829-35. doi: 10.1016/j.ejso. 2011.04.012.
