DOES FIBRIN GLUE IMPROVE DRAINAGE AFTER AXILLARY LYMPH-NODE DISSECTION

The aim of this prospective and randomized study was to establish whether the use of fibrin glue was beneficial after axillary lymph node dissection. From January 1990 to January 1991, 40 women were randomized before surgery for breast cancer: 20 patients (group A) underwent vaporization of fibrin glue (Tissucol(R), 5 ml of 500 IU thrombin) only in the area of axillary dissection; another 20 patients (group B) served as controls. The two groups were compared for age, number of nodes removed and involved, volume and duration of fluid drainage and complications. Student's t test, Mann-Whitney nonparametric test and the chi(2) test were used when appropriate for statistical analysis. The two groups were well balanced for age, number of nodes removed and involved, staging and histologic findings. The average volume of lymphorrhea in the lymph node dissection area was greater after use of fibrin glue (410.4 ml) than in controls (275.5 ml, p = 0.016). No difference was noted between the two groups for the volume of drainage fluid of the site of mastectomy or lumpectomy, or for the total volume of drainage fluid. Drainage duration as well as duration of hospital stay were similar. Six complications occurred in group A, and one in group B (p = 0.037). In contrast to our expectations, fibrin glue does not improve the postoperative period after axillary lymph node dissection; its application seems to be followed by more complications than in controls, which could be explained by the proteolytic activity of the lymph, the use of quick-acting fibrin sealant and the formation of two fibrin films in the armpit before the end of the surgical procedure.