A CLINICAL STUDY OF EFFECTIVENESS OF PROPHYLACTIC IV METHYLPREDNISOLONE IN PREVENTION OF SEROMA FORMATION IN CARCINOMA BREAST PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY (MRM)

Abstract

BACKGROUND : Breast cancer is currently one of the leading causes of malignancy in women. Incidence of ‘Breast Cancer’ was estimated to be 28.2% of all female cancers with 216,108 cases by 2022 in India. 272,454 cases were seen in the United States in 2021. More than two million cases were noted worldwide in the year 2022. The incremental application of newer diagnostic tools, effective surgical and adjuvant medical treatments has substantially increased overall survival. The overall outcome regarding the prognosis after surgery is dependent on various factors like age, stage of carcinoma, estimated blood loss and comorbidities1. MRM is the most commonly performed surgery for ‘Breast Cancer’, which has its own local complications. Among the various post op complications encountered, seroma formation is a common one. Various methods have been advocated by which post operative seroma formation can be reduced and they include quilting to eliminate dead space, local or topical application of various agents like steroids, gentamycin, platelet rich plasma, octreotide2. There is limited evidence from some studies that a single preoperative dose of steroids decreases seroma formation over the first 2 postoperative periods, but the difference is not maintained after this period3. More studies are needed because at present the available evidence does not support the use of steroids for prevention of seroma after MRM. Hence, we would like to study if administration of 120mg of IV methylprednisolone preoperatively, is really beneficial in reducing seroma formation post operatively in carcinoma breast patients undergoing MRM. xvii METHODOLOGY: All patients diagnosed to have carcinoma breast fulfilling inclusion and exclusion criteria and who underwent MRM at RL Jalappa Hospital and who volunteered for the study are being considered in the study. Patients were divided into group A or B by randomisation / odd and even method. Patients in group A were the study group. These patients received 120mg of methylprednisolone IV 1 hour before the surgery. Patients in group B are the control group who did not receive IV methylprednisolone. All patients underwent standard MRM. At the end of surgery, a closed suction drain was placed and the amount of drain was documented everyday till drains were removed. Wound was closely observed for seroma formation, fullness, redness, fluctuation. If any infection, culture and sensitivity of the wound was done and appropriate antibiotics was given. Results thus obtained was documented and analysed using statistical methods. Independent t-test was applied to calculate difference between means and a p-value <0.05 was considered as statistically significant level for all comparisons. RESULTS: The mean age was 64 years. The mean drainage in group A was significantly reduced as compared to group B (163ml vs. 279ml). Total drainage days were reduced (5 days vs. 7 days). The mean post op hospital stay was reduced (10.18 days vs 15.25 days). VAS pain score on POD 3 was reduced (2.56 vs 5.43). CONCLUSION: Findings of the study clearly establish a significant reduction in seroma formation and early removal of drain in patients who received IV Methylprednisolone pre operatively. There was significant reduction in duration of stay of patients in the hospital and reduction in post operative pain. There was no SSI noted during the study.