PROSPECTIVE STUDY ON THE EFFECTIVENESS OF METHYLPREDNISOLONE IN REDUCING SEROMA AND DRAIN OUTPUT AFTER MODIFIED RADICAL MASTECTOMY

Abstract

Abstract

Background: Breast cancer is the most common cancer affecting women worldwide and is a leading cause of cancer-related deaths. Surgery remains the primary treatment for most patients with operable breast cancer. Mastectomy is the surgical removal of the entire breast and is commonly performed for large, multicentric, or locally advanced tumors. Modified radical mastectomy is one of the most frequently performed procedures and includes removal of the breast along with axillary lymph nodes. Although mastectomy is an effective treatment, it is associated with several postoperative complications. Common complications include seroma, hematoma, wound infection, skin flap necrosis, and prolonged drainage. Among these, seroma formation is the most frequent complication after surgery1. These complications can delay wound healing, prolong hospital stay, and postpone adjuvant therapy. Various surgical techniques and medical interventions have been used to reduce postoperative complications. Improving postoperative outcomes is essential to enhance recovery and quality of life in patients undergoing mastectomy. This study evaluates the effect of preoperative intravenous methylprednisolone in reducing postoperative drain output and seroma incidence2,3.

Methods: A randomized, prospective, comparative study was conducted in the Department of General Surgery at Sapthagiri institute of medical sciences, Bangaluru, involving 62 female patients scheduled for elective MRM with Ca breast for 9 months from march 1st 2024 to november  30th 2024. Participants were randomly assigned into two equal groups: Group A (intervention), which received 120 mg of intravenous methylprednisolone one hour before surgery, and Group B (control), which received standard perioperative care. The primary outcome measures were daily drain output, duration of drain placement, and the incidence of postoperative seroma.

Results: Group A showed a statistically significant reduction in postoperative drain output during the early postoperative period. Mean drain volumes were significantly lower on Day 1 (82.5 ± 5.51 mL vs. 92.77 ± 23.74 mL; p=0.015), with similar significant differences observed on Days 3 (p=0.021) and 4 (p=0.015). Accordingly, 93.33% of patients in Group A had their drains removed by Day 5, whereas delayed drain removal until Day 6 occurred more frequently in Group B (13.33%). Although the incidence of seroma was lower in Group A (9.4%) than in Group B (11.33%), the difference was not statistically significant..

Conclusion: A single preoperative dose of 120 mg methylprednisolone significantly reduces early postoperative drain output and facilitates earlier drain removal in patients undergoing modified radical mastectomy. This simple, cost-effective intervention may help reduce postoperative morbidity, enhance recovery, and enable the timely initiation of adjuvant therapy and potential to reduce the duration of hospital stay.