c81cbc09a9984bb57bb543d1bd3031d2 cancers-17-02201-v2.pdf 1823006a51999df4222f04b00b1a15f91a120f44 cancers-17-02201-v2.pdf b11538ea31a9897d3e54093ab16392d2588dc15a55f24419dff402cb73a607b5 cancers-17-02201-v2.pdf Title: Breaking Dogmas in Axillary Lymphadenectomy and Quality of Life Subject: Axillary lymph node dissection (ALND), although increasingly less necessary, is still required in specific breast cancer surgery scenarios, such as cases with a high axillary tumor burden. However, traditional practices are being reassessed due to the associated morbidity and impacts on recovery. This review explores five critical and controversial innovations in ALND: (1) same-day discharge, (2) omission of surgical drains, (3) application of fibrin sealants, (4) minimally invasive techniques, and (5) their collective influence on quality of life (QoL). Same-day discharge has proven to be safe and cost-effective, increasing patient satisfaction without raising complication rates. The omission of drains, while slightly increasing seroma volumes, is linked to shorter hospital stays and fewer complications. The use of fibrin sealants shows promising results in reducing the seroma volume and duration, expediting recovery, although their routine use remains under debate. Minimally invasive and endoscopic techniques reduce morbidity and improve cosmetic outcomes while maintaining oncological safety. Quality of life (QoL) is essential in the evaluation of breast cancer treatment and is evaluated using tools such as EORTC QLQ-C30, QLQ-BR23, and FACT-B, SF-36, which assess physical, emotional, and psychosocial recovery. Innovations in ALND seem to improve QoL by minimizing pain, increasing arm function, and reducing psychological stress, underscoring the importance of patient-centered strategies. Although axillary lymphadenectomy increases arm morbidity compared to sentinel node biopsy, its overall impact on quality of life appears limited, likely due to the overlapping effects of systemic therapies and breast surgery. Keywords: breast cancer; axillary lymphadenectomy; drain; sealant; ambulatory; minimal invasive surgery; quality of life Author: Sandra López Gordo, Jaime Jimeno-Fraile, Anna García-Monferrer, Pau Nicolau, Neus Ruiz-Edo, Elena Ramirez-Maldonado, Santiago Rojas and Cristina Serra-Serra Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Fri Jul 4 03:33:23 2025 CEST ModDate: Fri Jul 4 03:43:58 2025 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 22 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 518179 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- TXLXUW+VnURWPalladioL Type 1 Custom yes yes yes 10 0 XYFGZC+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 WYKFGV+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 CBQPDL+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 JMNOBL+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 80 0 JMNOCL+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 86 0 JMNODM+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 92 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-09-09 03:10:56 CEST RepresentationInformation: cancers-17-02201-v2.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-09-08 11:13:49 CEST Size: 518179 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 431 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Ambulatory Surgery and Early Discharge After ALND Destination: section.3 Children: Item: Title: Benefits of Ambulatory Surgery Destination: subsection.3.1 Item: Title: The Role of ERAS Protocols in Facilitating Early Discharge Destination: subsection.3.2 Item: Title: Early Discharge Feasibility and Alternatives to Drains Destination: subsection.3.3 Item: Title: Economic Impact of Ambulatory Surgery Destination: subsection.3.4 Item: Title: Omission of Surgical Drains in Lymphadenectomy Destination: section.4 Children: Item: Title: Types of Drainage Protocols Destination: subsection.4.1 Item: Title: Use of Drains Destination: subsection.4.2 Item: Title: Alternative Techniques to Reduce Seroma Destination: subsection.4.3 Item: Title: Recent Scientific Evidence Destination: subsection.4.4 Item: Title: Use of Tissue Sealants in ALDN Destination: section.5 Children: Item: Title: Types of Sealants Destination: subsection.5.1 Children: Item: Title: Fibrin-Based Sealants Destination: subsubsection.5.1.1 Item: Title: Polyethylene Glycol (PEG)-Based Sealants Destination: subsubsection.5.1.2 Item: Title: Cyanoacrylate-Based Sealants Destination: subsubsection.5.1.3 Item: Title: Thrombin and Fibrinogen Combipatches Destination: subsubsection.5.1.4 Item: Title: Minimally Invasive and Endoscopic Surgical Approaches Destination: section.6 Children: Item: Title: Endoscopic Axillary Lymphadenectomy Destination: subsection.6.1 Item: Title: Robotics and the New Frontier of Axillary Surgery Destination: subsection.6.2 Item: Title: Breast Cancer Axillary Lymphadenectomy and Quality of Life Destination: section.7 Children: Item: Title: Introduction Destination: subsection.7.1 Item: Title: Conservative Surgery of the Axilla Destination: subsection.7.2 Item: Title: Quality of Life and Breast Cancer Surgery Destination: subsection.7.3 Item: Title: Discussion Destination: section.8 Children: Item: Title: Ambulatory ALDN Destination: subsection.8.1 Item: Title: Use of Drains Destination: subsection.8.2 Item: Title: Use of Sealants Destination: subsection.8.3 Item: Title: Minimally Invasive ALDN Destination: subsection.8.4 Item: Title: Quality of Life and ALDN Destination: subsection.8.5 Item: Title: Clinical Considerations Destination: subsection.8.6 Item: Title: Limitations Destination: section.9 Item: Title: Future Directions Destination: section.10 Item: Title: Conclusions Destination: section.11 Item: Title: References Destination: section.12 Info: Title: Breaking Dogmas in Axillary Lymphadenectomy and Quality of Life Author: Sandra López Gordo, Jaime Jimeno-Fraile, Anna García-Monferrer, Pau Nicolau, Neus Ruiz-Edo, Elena Ramirez-Maldonado, Santiago Rojas and Cristina Serra-Serra Subject: Axillary lymph node dissection (ALND), although increasingly less necessary, is still required in specific breast cancer surgery scenarios, such as cases with a high axillary tumor burden. However, traditional practices are being reassessed due to the associated morbidity and impacts on recovery. This review explores five critical and controversial innovations in ALND: (1) same-day discharge, (2) omission of surgical drains, (3) application of fibrin sealants, (4) minimally invasive techniques, and (5) their collective influence on quality of life (QoL). Same-day discharge has proven to be safe and cost-effective, increasing patient satisfaction without raising complication rates. The omission of drains, while slightly increasing seroma volumes, is linked to shorter hospital stays and fewer complications. The use of fibrin sealants shows promising results in reducing the seroma volume and duration, expediting recovery, although their routine use remains under debate. Minimally invasive and endoscopic techniques reduce morbidity and improve cosmetic outcomes while maintaining oncological safety. Quality of life (QoL) is essential in the evaluation of breast cancer treatment and is evaluated using tools such as EORTC QLQ-C30, QLQ-BR23, and FACT-B, SF-36, which assess physical, emotional, and psychosocial recovery. Innovations in ALND seem to improve QoL by minimizing pain, increasing arm function, and reducing psychological stress, underscoring the importance of patient-centered strategies. Although axillary lymphadenectomy increases arm morbidity compared to sentinel node biopsy, its overall impact on quality of life appears limited, likely due to the overlapping effects of systemic therapies and breast surgery. 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