Hemopatch Versus Axillary Drainage After Axillary Lymphadenectomy

NCT ID: NCT04487561

Last Updated: 2023-02-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

228 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-01

Study Completion Date

2023-02-14

Brief Summary

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Aspirative drainage continues to be the "gold standard" for the management of this post-surgical complication, even though it can lead to complications such as obstruction of the drainage, peritubal leakage of the seroma, etc. This may result in pain and reduction in mobility of the affected arm.

Based on our positive clinical outcomes and the fact that there is not any published data available in the literature regarding this use of the patch, the investigators propose a multicentric, randomized controlled clinical trial, with the objective of comparing the Hemopatch® with the usual technique used (aspirative drainage) in terms of efficacy and safety.

Hypothesis: Placing a Hemopatch ® instead of an aspirative drainage in women after undergoing axillary lymph node dissection during breast cancer surgery may reduce the appearance of seroma and consequently the need for a puncture, as well as the complications related to aspirative drainage.

Detailed Description

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1. Introduction:

In the surgical management of breast cancer, a conservative approach is the "gold standard" for the mammary region. For the axillary region, however, this depends on the results of the sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) continuing to be an indispensable procedure when the disease reaches this level.

The complications that arise from this procedure can be divided in two groups: 1) early: seromas and nerve lesions and 2) late: lymphedema, functional disorders in shoulder movement and post-mastectomy pain syndrome.

Seromas are the most frequent complications after an ALND. In themselves, they do not carry a high risk of morbidity. However, they delay healing of the surgical wound, increasing the risk of infection and number of ambulatory visits and furthermore, resulting in a deferral in the start of adjuvant therapies such as radio and chemotherapy.

Aspirative drainage continues to be the "gold standard" for the management of this post-surgical complication, even though it can lead to complications such as obstruction of the drainage, peritubal leakage of the seroma, etc. This may result in pain and reduction in mobility of the affected arm.

Hemopatch® is a hemosthatic sealer made from reabsorbable collagen. It comes in the from of patch, with CE marking that is already being used in the clinical setting in Spain and the rest of Europe.

Taking into account the factors that reduce seroma formation after ALND and the characteristics of the patch, its application after surgery could be useful in preventing seroma formation. More specifically, the patch has proven to act as a
* Hemosthatic, improving the first phase of inflammation
* Adhesive, reducing the dead space left after ALND
* Sealer, decreasing the exudate
2. Rationale Based on this premise and in the context of a clinical protocol after the introduction of the patch in daily clinical practice, it was used on 28 patients that underwent ALND, obtaining favourable clinical results. This is a multicentric, randomized controlled clinical trial, with the objective of comparing the Hemopatch® with the usual technique used (aspirative drainage) in terms of efficacy and safety.
3. Hypothesis Placing a Hemopatch ® instead of an aspirative drainage in women after undergoing ALND during breast cancer surgery may reduce the appearance of seroma and consequently the need for a puncture, as well as the complications related to aspirative drainage.

Conditions

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Breast Cancer Breast-conserving Surgery Axillary Lymph Node Dissection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective multicentric randomized controlled clinical trial
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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aspirative drainage

Drainage is the usual treatment after axillary lymphadenectoma for breast cancer

Group Type OTHER

Aspirative drainage

Intervention Type PROCEDURE

The patient will be randomized after performing the lymphadenectomy, according to a table of random numbers performed in excel kuytools, then a compression bandage will be performed on all the patients and it will be controlled 24 hours postoperatively, the subsequent control will be weekly until the drain is removed. and / or the disappearance of the seroma

Hemopatch

The hemopatch group will be the group without drainage and with a product patch

Group Type ACTIVE_COMPARATOR

hemopatch

Intervention Type DEVICE

The patient will be randomized after performing the lymphadenectomy, according to a table of random numbers performed in excel kuytools, then a compression bandage will be performed on all the patients and it will be controlled 24 hours postoperatively, the subsequent control will be weekly until the drain is removed. and / or the disappearance of the seroma

Interventions

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hemopatch

The patient will be randomized after performing the lymphadenectomy, according to a table of random numbers performed in excel kuytools, then a compression bandage will be performed on all the patients and it will be controlled 24 hours postoperatively, the subsequent control will be weekly until the drain is removed. and / or the disappearance of the seroma

Intervention Type DEVICE

Aspirative drainage

The patient will be randomized after performing the lymphadenectomy, according to a table of random numbers performed in excel kuytools, then a compression bandage will be performed on all the patients and it will be controlled 24 hours postoperatively, the subsequent control will be weekly until the drain is removed. and / or the disappearance of the seroma

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of breast cancer,
* scheduled for surgical treatment including conservative surgery and ALND.
* Signed informed consent for ALND.

Exclusion Criteria

* Selective sentinel node biopsy negative.
* Subsidiary mastectomy patients.
* Denial of informed consent for axillary lymphadenectomy.
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Fundación para la Investigación del Hospital Clínico de Valencia

OTHER

Sponsor Role lead

Responsible Party

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Elvira Buch

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Hospital Clínico Universitario de Valencia

Valencia, , Spain

Site Status

Countries

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Spain

References

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Lewis KM, Ikeme S, Olubunmi T, Kuntze CE. Clinical effectiveness and versatility of a sealing hemostatic patch (HEMOPATCH) in multiple surgical specialties. Expert Rev Med Devices. 2018 May;15(5):367-376. doi: 10.1080/17434440.2018.1464909. Epub 2018 Apr 26.

Reference Type BACKGROUND
PMID: 29658322 (View on PubMed)

Droeser RA, Frey DM, Oertli D, Kopelman D, Baas-Vrancken Peeters MJ, Giuliano AE, Dalberg K, Kallam R, Nordmann A. Volume-controlled vs no/short-term drainage after axillary lymph node dissection in breast cancer surgery: a meta-analysis. Breast. 2009 Apr;18(2):109-14. doi: 10.1016/j.breast.2009.02.003. Epub 2009 Mar 16.

Reference Type BACKGROUND
PMID: 19289285 (View on PubMed)

Aitken DR, Minton JP. Complications associated with mastectomy. Surg Clin North Am. 1983 Dec;63(6):1331-52. doi: 10.1016/s0039-6109(16)43192-0. No abstract available.

Reference Type BACKGROUND
PMID: 6359504 (View on PubMed)

Kottayasamy Seenivasagam R, Gupta V, Singh G. Prevention of seroma formation after axillary dissection--a comparative randomized clinical trial of three methods. Breast J. 2013 Sep-Oct;19(5):478-84. doi: 10.1111/tbj.12164. Epub 2013 Jul 19.

Reference Type BACKGROUND
PMID: 23865902 (View on PubMed)

Weber WP, Tausch C, Hayoz S, Fehr MK, Ribi K, Hawle H, Lupatsch JE, Matter-Walstra K, Chiesa F, Dedes KJ, Berclaz G, Lelievre L, Hess T, Guth U, Pioch V, Sarlos D, Leo C, Canonica C, Gabriel N, Zeindler J, Cassoly E, Andrieu C, Soysal SD, Ruhstaller T, Fehr PM, Knauer M; Swiss Group for Clinical Cancer Research (SAKK). Impact of a Surgical Sealing Patch on Lymphatic Drainage After Axillary Dissection for Breast Cancer: The SAKK 23/13 Multicenter Randomized Phase III Trial. Ann Surg Oncol. 2018 Sep;25(9):2632-2640. doi: 10.1245/s10434-018-6556-9. Epub 2018 Jun 8.

Reference Type BACKGROUND
PMID: 29948418 (View on PubMed)

He XD, Guo ZH, Tian JH, Yang KH, Xie XD. Whether drainage should be used after surgery for breast cancer? A systematic review of randomized controlled trials. Med Oncol. 2011 Dec;28 Suppl 1:S22-30. doi: 10.1007/s12032-010-9673-2. Epub 2010 Sep 9.

Reference Type BACKGROUND
PMID: 20827578 (View on PubMed)

Thomson DR, Sadideen H, Furniss D. Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev. 2013 Oct 20;2013(10):CD006823. doi: 10.1002/14651858.CD006823.pub2.

Reference Type BACKGROUND
PMID: 24158902 (View on PubMed)

Petrek JA, Blackwood MM. Axillary dissection: current practice and technique. Curr Probl Surg. 1995 Apr;32(4):257-323. doi: 10.1016/s0011-3840(05)80015-2. No abstract available.

Reference Type BACKGROUND
PMID: 7705102 (View on PubMed)

Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, Saito S. Pathophysiology of seroma in breast cancer. Breast Cancer. 2005;12(4):288-93. doi: 10.2325/jbcs.12.288.

Reference Type BACKGROUND
PMID: 16286909 (View on PubMed)

Bonnema J, Ligtenstein DA, Wiggers T, van Geel AN. The composition of serous fluid after axillary dissection. Eur J Surg. 1999 Jan;165(1):9-13. doi: 10.1080/110241599750007441.

Reference Type BACKGROUND
PMID: 10069628 (View on PubMed)

McCaul JA, Aslaam A, Spooner RJ, Louden I, Cavanagh T, Purushotham AD. Aetiology of seroma formation in patients undergoing surgery for breast cancer. Breast. 2000 Jun;9(3):144-8. doi: 10.1054/brst.1999.0126.

Reference Type BACKGROUND
PMID: 14731838 (View on PubMed)

Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection: a randomized prospective study. Ann Surg. 1981 Mar;193(3):288-95. doi: 10.1097/00000658-198103000-00007.

Reference Type BACKGROUND
PMID: 7011221 (View on PubMed)

Pinero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrion J, Canteras-Jordana M. Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol. 2016 Sep;114(4):423-7. doi: 10.1002/jso.24344. Epub 2016 Jun 23.

Reference Type BACKGROUND
PMID: 27338717 (View on PubMed)

Conversano A, Mazouni C, Thomin A, Gaudin A, Fournier M, Rimareix F, Bonastre J. Use of Low-Thrombin Fibrin Sealant Glue After Axillary Lymphadenectomy for Breast Cancer to Reduce Hospital Length and Seroma. Clin Breast Cancer. 2017 Jul;17(4):293-297. doi: 10.1016/j.clbc.2016.12.013. Epub 2017 Jan 10.

Reference Type BACKGROUND
PMID: 28161131 (View on PubMed)

Vasileiadou K, Kosmidis C, Anthimidis G, Miliaras S, Kostopoulos I, Fahantidis E. Cyanoacrylate Adhesive Reduces Seroma Production After Modified Radical Mastectomy or Quadrantectomy With Lymph Node Dissection-A Prospective Randomized Clinical Trial. Clin Breast Cancer. 2017 Dec;17(8):595-600. doi: 10.1016/j.clbc.2017.04.004. Epub 2017 Apr 13.

Reference Type BACKGROUND
PMID: 28673765 (View on PubMed)

Buch-Villa E, Castaner-Puga C, Delgado-Garcia S, Fuster-Diana C, Vidal-Herrador B, Ripoll-Orts F, Galeote-Quecedo T, Prat A, Andres-Matias M, Jimeno-Fraile J, Munoz-Sorsona E, Vento G, Gumbau-Puchol V, Adrianzen M, Lopez-Flor V, Ortega J. Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial. Br J Surg. 2023 Aug 11;110(9):1180-1188. doi: 10.1093/bjs/znad150.

Reference Type DERIVED
PMID: 37311694 (View on PubMed)

Related Links

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http://www.eortc.org

Survey of Eortc QLQ- BR23

http://www.ncbi.nlm.nih.gov/pubmed/16286909

Pathophysiology of seroma in breast cancer. Breast Cancer \[Internet\]. 2005;12(4):288-93.

Other Identifiers

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REDHEMOPACH

Identifier Type: -

Identifier Source: org_study_id

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