Evaluation of ultrasonic axillary dissection in preservation of intercostobrachial nerve and lymphatic sealing in breast cancer patients: Randomized controlled trial

Ahmed M F Salama; Ahmed M Nawar; Mohamed E Zayed; Mohamed S Essa

doi:10.1016/j.amsu.2020.10.059

Evaluation of ultrasonic axillary dissection in preservation of intercostobrachial nerve and lymphatic sealing in breast cancer patients: Randomized controlled trial

Ann Med Surg (Lond). 2020 Nov 1:60:255-260. doi: 10.1016/j.amsu.2020.10.059. eCollection 2020 Dec.

Authors

Ahmed M F Salama¹, Ahmed M Nawar¹, Mohamed E Zayed¹, Mohamed S Essa¹

Affiliation

¹ Department of General Surgery, Benha University Hospital, Faculty of Medicine, Benha University, Benha, Egypt.

Abstract

Background: Electrocautery has been shown to be associated with excessive serous drainage which may lead to many complications in patients with breast cancer needing dissection of the axillary lymph nodes. The Harmonic Focus could outperform electrocautery in dissection of axillary lymph nodes, resulting in shortening of the operative times and minimize postoperative complications. This study aims to compare the mean axillary drain production and the axillary numbness frequency in axillary lymph node dissection (ANLD) during Modified Radical Mastectomy (MRM) and breast conservative surgery (BCS) between the use of harmonics scalpel and electrocautery.

Methods: This study includes 40 patients presented with early breast cancer (T1 and T2) underwent BCS or MRM in general surgery department, Faculty of Medicine, Benha University Hospital during the period from January 2017 to September 2019. The patients randomly assigned into 2 groups; group A: subjected to ANLD using Harmonic Focus tool and group B: subjected to ANLD using electrocautery. Operative time, total drainage volume, blood loss, duration of the drain and frequency of axillary numbness were recorded.

Results: This study shows that using Harmonic in axillary dissection considerably reduced operating time, total drainage volume, blood loss, days of hospital stays and reduced axillary numbness level in comparison to conventional electrocautery.

Conclusion: Compared to the normal electrocautery, the harmonic focus dissection has major advantages in lowering postoperative drainage, blood loss intra-operative and lower incidence of axillary numbness in breast cancer axillary dissection, without affecting operating time.

Keywords: ANLD, Axillary lymph node dissection; Axillary numbness; BCS, Breast conservative surgery; CONSORT, Consolidated Standards of Reporting Trials; Drainvolume; Electrocautery; FDA, Food and drug administration; Harmonic; MRM, Modified radical mastectomy; SLNB, Sentinel Lymph node biopsy; UIN, Unique Identifying Number.