Clipping versus Electrocautery in Axillary Lymph Node Dissection: An Observational Study

Background: Breast cancer is the most common malignancy in Indian females, Surgical excision (MRM or BCS), which entails removal of breast tissue and axillary lymph node dissection with or without chemo-radiotherapy. Seroma formation and wound dehiscence are the most common local complications after the surgery. Use of electrocautery during the surgery reduces intra-operative bleeding but chances of seroma increase due to increased inflammatory response due to thermal tissue damage when compared to the use of Ligaclips. Aims and Objectives: This study was aimed at comparing the effectiveness of Ligaclips versus electrocautery in terms of lymph production, duration of drain placement, incidence of seroma formation, and local wound complications following axillary lymph node dissection. Materials and Methods: It was an observational study conducted at an onco-surgery centre in India, where the clinical outcomes of clipping (from July 2022 to June 2024) were compared with historical cohort (from July 2020 to June 2022) in which electrocautery was used during the surgery. Results: A total of 180 patients (Cases – 95 and Control- 85) were included in this study and all were treated by single surgeon. Average age of patient was 47 and 53 years in case and control group respectively. Mean drain output per day among cases and controls were 46 ml and 65 ml respectively, which was statistically significant ( P -Value 0.01) and total drain output among cases and control were 381 and 532 ml, which was statistically significant ( P Value 0.013) as well. The time of drain removal in the Ligaclip versus electrocautery group was 7 and 8.6 days respectively. Overall complications (Seroma, wound dehiscence) in the Ligaclip group were lesser than the electrocautery group (chi square 8.099, P -value- 0.0174). Conclusion: Use of Ligaclips was superior to electrocautery in our study, as it significantly reduced the incidence of wound dehiscence and seroma formation in the postoperative period, thereby lowering morbidity and improving patient outcomes.