Nature of axillary drainage fluid after axillary lymph node dissection in breast cancer

Introduction: Prolonged postoperative axillary drainage is a common cause of morbidity after axillary lymph node dissection (ALND). There no consensus about the nature of fluid in prolonged axillary drainage. The aim of our prospective observational study was to determine the nature of axillary drainage fluid and to study the change in its composition with prolonged drainage. Materials and Methods: Thirty breast cancer patients scheduled to undergo ALND were evaluated by preoperative hemogram, total protein, serum albumin, serum globulin and A:G (albumin:globulin) ratio, and a complete lipid profile, which was repeated on 5 ^th postoperative day, along with serum interleukin 1β, interleukin 6, tumor necrosis factor (TNF)-α, and interferon γ. The daily and total axillary drainage was recorded till removal of drain. The axillary fluid was evaluated for total and differential cell count, proteins, triglycerides, and cholesterol on the 3 ^rd , 5 ^th , and 7 ^th postoperative day (POD), and for interleukin 1β, interleukin 6, TNF-α, and interferon γ on 5 ^th POD. Observations: Axillary fluid leukocyte count increased initially but then decreased; from initial polymorpholeukocytoses, it became predominantly lymphocytes by 7 ^th day. On the 5 ^th POD, axillary fluid inflammatory cytokine levels exceeded serum values by several times. Cholesterol and low-density lipoprotein levels in the drain fluid increased initially and then decreased by 7 ^th day. Total protein content, albumin level, A:G ratio, and high-density lipoprotein levels decreased significantly and continuously. Triglycerides showed progressive increment from the 3 ^rd to the 7 ^th day. Conclusions: Axillary drainage fluid is initially an inflammatory exudate which changes to nature of lymph when the drainage is prolonged. It is important to prevent lymph leakage during and after mastectomy and to minimize the intensity and duration of the first phase of wound repair to decrease the morbidity due to prolonged axillary drainage.