Value of using ultrasonic shears in reducing seroma formation after axillary lymph node dissection in breast cancer patients.

Background: Axillary lymph node dissection (ALND) is an essential step in the management of breast cancer. ALND is conventionally performed using radio frequency electrosurgery. The post-operative complications of utilizing such energy (such as prolonged drainage time, seroma, or infection) lead to prolonged recovery. Hence, it may delay the initiation of adjuvant chemo/radiotherapy for this critical category of patients. Using ultrasound shears provides a wide spectrum of tissue effects via mechanical oscillation. The absence of an electric circuit in ultrasound shears reduces thermal injury and accordingly cellular damage.

Objective: Comparing utilization of ultrasound shears in axillary lymph node dissection to conventional radio frequency electrosurgery in terms of operative time, post-operative drainage amount and days, post-operative pain, the incidence of seroma or infection, and lymph node yield.

Methods: This study is a randomized control trial. It includes 56 breast cancer ALND cases performed in conjunction with either BCS or MRM; being upfront surgery cases or post-neoadjuvant therapy cases, 28 patients underwent ALND using ultrasound shears and 28 underwent ALND using radio frequency electrosurgery.

Results: The mean age of the study population was 51 ± 11.7 years, with a mean BMI of 39. The mean operative time in the ultrasound shear group was 29.4. ± 7.6 min and 31.6 ± 5.1 min in the conventional group. The mean amount of drainage in the ultrasound shear group was 319.6 ± 75.4 ml and 407.5 ± 75.2 ml in the conventional group. The mean drainage days in the ultrasound shear group were 8 ± 1 day and 12 ± 2.2 days in the conventional group. Seroma formation was recorded in 6 of the ultrasound shear groups and 9 in the conventional group. Seroma followed by infection was found in 10% of the ultrasound shear group versus 21% in the conventional group. Seroma formation and wound infection were significantly related to the conventional group (p-value = 0.01).

Conclusion: Our study recommends the utilization of ultrasound shears in ALND as it is a safe and accurate method that allows faster post-operative recovery with shorter drainage time and lower incidence of seroma or infection, without affecting operative time or lymph node yield.

Trial registration: Trial no.: PACTR202402831197428. Date of approval: 19/02/2024.