Determining the Efficacy of Octreotide on Lymphorrhea Formation in Patients With Early Breast Carcinoma After Modified Radical Mastectomy: A Randomized Controlled Trial

TL;DR

This study finds that octreotide reduces lymphorrhea after breast cancer surgery, with no major side effects.

Contribution

The study provides new evidence that octreotide can reduce postoperative lymphorrhea in early breast cancer patients undergoing mastectomy.

Findings

Octreotide significantly reduced lymphorrhea drainage volume compared to the control group.

The duration of drainage was shorter in the octreotide group.

Octreotide was well tolerated with no significant side effects observed.

Abstract

Background: Postoperative lymphorrhea and seroma formation are frequent complications after modified radical mastectomy (MRM) that can prolong recovery. Octreotide, a somatostatin analog with broad anti-secretory effects, has shown promise in reducing lymphatic drainage in various surgical settings. We conducted a randomized trial to evaluate the efficacy of octreotide in reducing lymphorrhea and seroma formation in patients with early breast cancer (stages I, IIA, and IIB) undergoing MRM.

Methods: Eighty patients with early breast carcinoma (stages I, IIA, and IIB) scheduled for MRM were randomly assigned to two groups (1:1 ratio). The octreotide group (n = 40) received injection octreotide subcutaneously 100 μg three times daily for five days and standard care postoperatively, while the control group received standard care without octreotide. Primary outcomes were the total volume of lymphorrhea drained until drain removal and the duration of drainage. Secondary outcomes included the incidence of postoperative seroma after drain removal, wound infection, flap necrosis, and length of hospital stay. Statistical analysis was performed using chi-square tests for categorical variables (α = 0.05) and t-tests for continuous variables.

Results: Octreotide significantly reduced the total lymphorrhea drainage volume (227.8 ± 181.4 ml; median 172.5, IQR 78.8-365.0) compared to the control group (364.1 ± 221.0 ml; median 352.5, IQR 198.8-562.5; U = 1081.5, p = 0.0068). The average duration of drainage was also shorter in the octreotide group (3.3 ± 1.7 days; median 3, IQR 2-4) than in the control group (4.1 ± 1.7 days; median 4, IQR 3-5; U = 1026, p = 0.0272). Daily drain output was significantly lower with octreotide (65.1 ± 41.4 ml/day; median 66.5, IQR 30-95) than in the control group (85.6 ± 48.7 ml/day; median 90, IQR 48-115; U = 1004.5, p = 0.0494). Seroma formation occurred in 30% of the octreotide group versus 35% of the control group (χ² = 0.06, p = 0.81). Wound infection (7.5% vs. 10%; OR = 0.73, p = 1.00) and flap necrosis (5% vs. 10%; OR = 0.47, p = 0.68) were low and did not differ significantly between groups. The mean postoperative hospital stay was slightly shorter with octreotide (5.8 ± 2.4 days; median 5, IQR 4-7) than with control (6.6 ± 2.3 days; median 6, IQR 5-8), although the difference did not reach statistical significance (U = 998.5, p = 0.054). No adverse drug-related effects (such as nausea, bradycardia, or hyperglycemia) were observed following octreotide administration.

Conclusion: Adjuvant octreotide significantly reduced the volume of lymphorrhea following MRM, with quicker drain removal indicating its potential to decrease drainage output. Although the octreotide group showed a trend towards lower seroma incidence, the relationship was not statistically significant in our sample. Octreotide was well tolerated with no significant side effects. These findings suggest octreotide can be a safe adjunct to standard surgical care to reduce lymphatic drainage after MRM. Larger studies may further clarify its impact on seroma formation and recovery.

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