Factors Predicting Seroma Formation after Axillary Lymph Node Clearance.

Author(s): Dr. Mohammed Mujtaba Ali

BACKGROUND We wanted to investigate as to which variable like age, weight, stage, prior chemotherapy, radiation therapy etc. had a significant association with the patient developing collection of serous fluid in the axilla in the post-operative period following axillary lymph node clearance. METHODS This is a retrospective study. All patients who underwent axillary clearance were included in the study including elective and therapeutic indications. All relevant clinical data was extracted from these patients. The clinical variables were studied to reveal the most significant variable associated with formation of seroma RESULTS Axillary dissection was carried out in 133 patients, 70 patients as a part of modified radical mastectomy for carcinoma breast, 39 patients as a part of breast conserving surgery for carcinoma breast, 12 patient as a part of completion surgery for patients who underwent mastectomy elsewhere for carcinoma breast in which axilla was not addressed, 6 patient with melanoma of the upper limb and 4 for squamous cell carcinoma of upper limb and 2 for sarcoma for the upper limb. Incidence of seroma was 43.47 in >60 yrs. vs 31.04 in <60 yrs., 80% in males vs 33.60% in females, 29.14% for tumour size of 2 cm vs 37.25% for 2-5 cm, vs 41.97% for > 5 cms, 38.46% nodal metastasis vs 28.57 no nodal metastasis, 34.28% in MRM vs 23.07% in BCS vs 41.66% in Completion Mastectomy, neoadjuvant chemotherapy had 54.84% vs 29.41% in no prior chemotherapy, infection/flap necrosis 83.33% vs 30.58 in no infection/ flap necrosis, 85.71% when drainage duration 5 days vs 75% when 5 to 10 days vs 20.40% when more than 10 days. Melanoma and sarcoma histology had higher incidence of seroma formation. CONCLUSIONS Male sex, older age, larger tumour size, nodal involvement, completion surgery or re-surgery, histology like melanoma or sarcoma, neoadjuvant chemotherapy, prior irradiation, infection or flap necrosis, and early removal of drain is associated with higher incidence of post-operative seroma formation.