title: Ultrasonic dissection system technology in breast cancer: a case-control study in a large cohort of patients requiring axillary dissection.
abstract: In the sentinel node era, axillary dissection (ALND) for breast cancer (BC) is required much less frequently than in the past. However, complications, such as prolonged drainage output and seroma formation, are still observed. Harmonic dissection devices (HDDs) are widely used in laparoscopic and minimally invasive surgery to reduce collateral damage during tissue dissection, but its usefulness in breast surgery is unclear. The aim of this study was to evaluate the efficacy of HDDs compared to that of conventional dissection in performing ALND. One hundred thirty-nine women (median age 61 years, range 34-71 years) with confirmed pT1-2 primary infiltrating ductal BC undergoing curative surgery were enrolled in the study. The population was prospectively randomized between two age- and stage-matched arms: group A (cases)-68 (48.9 %) patients (HDD technique), versus group B (controls)-71 (51.1 %) patients (conventional technique). In group B, skin flaps were obtained using a scalpel, scissors, and electrocautery which was never used for ALND. In group A, for each operation time, the HDDs were used exclusively. The mean operative time, intraoperative blood loss, and drainage output were (A vs. B) 95 ± 22 versus 109 ± 25 min, 56 ± 12 versus 86 ± 15 mL, and 412 ± 83 versus 456 ± 69 mL, respectively (p < 0.01). Twenty-nine (20.9 %) patients developed an axillary seroma: 9 (13.2 %) and 20 (28.2 %) for groups A and B, respectively (p = 0.030). Our study confirms that in patients with BC requiring ALND the use of HDDs is more time efficient than conventional surgery, and reduces intraoperative bleeding, the amount of drainage, and the risk of seroma formation. These results may lead to several short- and long-term advantages. Thus, a careful evaluation of the cost-benefits of nontraditional tools, such as HDDs, should be performed in all patients undergoing modified radical or partial mastectomy and ALND for BC.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology (DiSCOG), School of Medicine, University of Padua, Padova, Italy, flumachi@unipd.it.
authors.forename: F
authors.initials: F
authors.lastname: Lumachi
authors.forename: S M M
authors.initials: SM
authors.lastname: Basso
authors.forename: D A
authors.initials: DA
authors.lastname: Santeufemia
authors.forename: M
authors.initials: M
authors.lastname: Bonamini
authors.forename: G B
authors.initials: GB
authors.lastname: Chiara
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery; D016063:Blood Loss, Surgical; D001943:Breast Neoplasms / Q000473:pathology*; D016022:Case-Control Studies; D004322:Drainage; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation / Q000379:methods; D049291:Seroma / Q000209:etiology; D013523:Surgical Equipment; D013524:Surgical Flaps; D014465:Ultrasonics