Lymphocele or Seroma After Modified Radical Mastectomy for Breast Cancer: Systematic Review and Meta-analysis.

Seroma or lymphocele remains the most common complication after mastectomy and lymphadenectomy for breast cancer. Many different techniques are available to prevent this complication. We searched MEDLINE, clinicaltrials.gov, Cochrane Library, and Web of Science databases for publications addressing the issue of prevention of lymphocele or seroma after mastectomy and axillary lymphadenectomy. Quality was assessed using a standardised tool. Incidence of seroma or lymphocele were collected. Fifteen randomized controlled trials including a total of 1,766 patients undergoing radical mastectomy and axillary lymphadenectomy for breast cancer were retrieved. The incidence of lymphocele or seroma in the study population was 24.2% (411/1698): 25.2% (232/920) in the test groups and 23.0% (179/778) in the control groups. Neither modification of surgical technique (RR= 0.86; 95%CI [0.72, 1.03]) nor application of a medical treatment (RR= 0.96; 95%CI [0.72, 1.29]) was effective in preventing lymphocele. On the contrary, decreasing the drainage time increased the risk of lymphocele (RR= 1.88; 95%CI [1.43, 2.48). To conclude, despite the heterogeneity of study designs, drainage appears to be the most effective technique.