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EJSO 39 (2013) 1037
Correspondence
Breast cancer surgery and suction drains: To do or not
to do!
Dear Editor,
The publication by Taylor et al. regarding no drain pol-
icy is important and could have a considerable impact on
hospital stay for breast cancer patients receiving axillary
lymph node dissection.1 There are however some weak-
nesses in the study. It is not a randomized controlled trail,
there is no distinction between high and low-pressure vac-
uum drains and there is no data regarding the long-term
morbidity of increased volume aspiration when no drains
are used.
In the published study a high-pressure vacuum drain is
used. The high vacuum drains produce significantly less
drainage fluid then no drains.1 A prospective randomized
clinical trial comparing low versus high vacuum suction
drainage showed that low suction drained significantly
less volume.2 High-pressure suction drainage probably con-
tributes to prolonged drainage due to the fact that the high
negative suction prevents the leaking lymphatics from seal-
ing off. Low-pressure suction drainage, on the otherhand
probably do allow the lymphatics to close. Based on these
results one may conclude that suction helps in the preven-
tion of seroma formation and that low suction drainage will
produce less drainage fluid then no drains, with a reduced
risk of rupturing nerves and vessel.3
The hospital stay in the no suction group and the low
vacuum suction group was significantly shorter then the
high-pressure vacuum suction in both studies.1,2 A signifi-
cant shorter hospital stay translates in a considerable reduc-
tion in medical costs and resources.
There is no difference in short-term morbidity between
no drains or low suction drainage versus high suction
drainage. Regarding the long-term morbidity there is no
0748-7983/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ejso.2013.05.013
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data. Theoretically if there is more fluid accumulating in
the axilla it is likely there is a distribution in the different
surrounding tissue layers. Can this accumulation translate
into morbidity?
In conclusion before abandoning suction drains at all the
long-term morbidity of a no drain policy should be evalu-
ated. It could well be that the low suction drainage is a mid-
dle way in on the one hand reduced stay and on the other
had reduced long term morbidity. Ideally a trail comparing
no drains, high- and low suction drainage should be per-
formed with sufficient follow up.
Conflict of interest statement
None.
References
1. Taylor JC, Rai S, Hoar F, Brown H, Vishwanath L. Breast cancer sur-
gery without suction drainage: the impact of adopting a ’no drains’ pol-
icy on symptomatic seroma formation rates. Eur J Surg Oncol 2013 Feb
1;(13):00002–4.. online doi:pii: S0748-7983.
2. Wedderburn A, Gupta R, Bell N, Royle G. Comparison between low
and high pressure suction drainage following axillary clearance. Eur
J Surg Oncol 2000;26(2):142–4.
3. Tjalma WA. Suction drain-induced haemorrhage after nerve- and
vessel-sparing axillary lymph node dissection for breast cancer. Breast
2006;15(3):443–5.
W.A.A. Tjalma
Gynecological Oncologist and Breast Surgeon, Medical
Coordinator of the University Multidisciplinary Breast
Clinic Antwerpen, Antwerp University Hospital,
University of Antwerp, Wilrijkstraat 10, 2650 Edegem,
Belgium
Tel.: þ32 3 821 59 04; fax: þ32 3 825 58 83.
E-mail address: Wiebren.Tjalma@uza.be