Postmastectomy seroma: how much is it affected by serum levels of IL-6 and CRP and how much is it reduced by intravenous hydrocortisone injection?

Abstract

Background Seroma is extremely common after breast surgery, and this could be because of the inflammatory response during wound healing. Several factors such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been detected in the seroma fluid that support this assumption; therefore, inhibition of the inflammatory response by using hydrocortisone might decrease seroma formation. We aimed to evaluate the effect of adding hydrocortisone to the anesthetic regimen in the perioperative serum level of IL-6 and CRP and consequently in postmastectomy seroma formation. Patients and methods The study included female patients with primary operable breast cancer who were randomly allocated to two groups; each included 40 patients. Patients in group I received general anesthesia with hydrocortisone, and patients in group II received general anesthesia without hydrocortisone. Venous samples were collected for measuring IL-6 serum levels before surgery, 6 h after the end of the procedure, and 24 h after the procedure and for measuring CRP serum levels before surgery and 24 h after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation, and management of seroma. Results Patients in group I had a lower total drainage volume ( P = 0.001), had the drain removed earlier ( P = 0.009), and had a lower incidence of postmastectomy seroma formation ( P = 0.005). Postoperative serum levels of IL-6 and CRP showed a significant decrease in group I compared with group II. Conclusion Postmastectomy seroma is likely a proinflammatory process and can be reduced by giving intravenous hydrocortisone on induction of anesthesia and 2 h later, which significantly decreases the inflammatory mediators (IL-6 and CRP) that significantly reduce the incidence of seroma.