Relationship between octreotide and breast surgery.

To the Editor: We would like to express our opinion about the article by Gonzalez et al. (1). We congratulate them on the well-performed study and the large number of patients included. We know that seroma formation is the most common complication of breast cancer surgery (2). We noted a few things in the article. First, the authors do not describe the amount of lymphorrhea aspirated and the number of aspirations during the postoperative medications. There is a big difference between an aspiration of 10 cc of seroma and an aspiration of 100 cc of lymphorrhea, but they describe only the mean number of aspirations. We believe the amount of aspiration and number of aspirations for every postoperative medication will be helpful in understanding the results. Second, we noted the absence of any information about the mean quantity of lymph loss with drains during the first postoperative days. The authors described only the removal of suction drains after 5 or 7 days, depending on the type of surgery performed. We would also like to know if the authors used some compressive medication with suction drains or if they placed only suction drains without compressive medication? We think that Gonzalez et al. could test compressive medication or other ways of preventing seroma formation. In our experience (3,4), the use of compressive medication is helpful, but not resolutive, in the treatment of seroma or lymphorrhea, where other authors tested axillary padding with encouraging results (5). We know that external axillary compression is not universally accepted to reduce seroma (6) formation, but we think that this kind of medication combined with suction drains will be useful, even if today some authors do not encourage the use of suction drains in breast surgery (7). Finally, we would like to remind readers that today in breast surgery we can take advantage of octreotide. In fact, octreotide can be used successfully for the treatment of postaxillary dissection lymphorrhea, and potentially in the prevention of postaxillary lymph node dissection lymphosarcoma, since the amount and duration of lymphorrhea in this setting are known to be important risk factors for its development. In fact, in our experience, the mean quantity (± standard deviation) of lymphorrhea was 94.6 ± 19 cc/day and the average duration was 16.7 ± 3.0 days. In comparison, the mean quantity of lymphorrhea in the treatment group was 65.4 ± 21.1 cc/day and the average duration was 7.1 ± 2.9 days. Potentially octreotide might be used in similar situations where lymphorrhea is detrimental, such as peripheral vascular surgery and regional lymph node dissection for melanoma. So we encourage the authors of this article to use octeotride in the treatment of lymphorrhea.