The effect of Modified Radical Mastectomy (MRM) with and without latissimus dorsi flap on seroma of Locally Advanced Breast Cancer (LABC) in Sanglah Hospital

Anak Agung Chris Tedy Pramana,I Gde Raka Widiana,I Ketut Widiana

doi:10.15562/ism.v12i2.1059

Anak Agung Chris Tedy Pramana, I Gde Raka Widiana + Show 1 more

Open Access

https://doi.org/10.15562/ism.v12i2.1059

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Abstract

Background: Locally Advanced Breast Cancer (LABC) is defined as breast cancer spread locoregionally and without any signs of metastasis. Stage IIIA breast cancer is one type of LABC that can be removed surgically, and Modified Radical Mastectomy (MRM) remains the first surgical option. Seroma production is one of the most common complications post MRM, with the hypothesis stating that the Latissimus Dorsi (LD) flap technique is responsible for resulting in higher seroma output. This study aims to compare seroma production in LABC patients post MRM with and without LD flap.Methods: This prospective cohort study was conducted in Sanglah General Hospital, Denpasar, between November 2018 and January 2020. The study sample was divided into 2 groups: LABC patients post MRM with and without LD flap reconstruction. Seroma was measured in milliliters (ml) and collected from the first to fifth day post-operation. Data were analyzed using SPSS version 21 for Windows.Results: Forty LABC patients were enrolled in this study. The mean age for the group without latissimus dorsi flap was 48.45±7.01 years and 49.40±10.77 years for the group with latissimus dorsi flap. The mean seroma production in LABC patients who underwent MRM without and with LD flap reconstruction was 696.45±66.37 ml and 490.10±62.11 ml. There was a significant difference in the total of seroma between the treatment group without-LD flap and compared to with-LD flap reconstruction (p<0.001).Conclusion: Seroma production is significantly higher in LABC patients post MRM without LD flap reconstruction than LABC patients with LD flap.

Highlights

Advanced Breast Cancer (LABC) is defined as breast cancer spread in locoregional but does not spread beyond the breast and regional lymph nodes.[1]
Seroma can make the patient anxious, causes discomfort, and disrupt wound healing. These reasons might cause necrotic flap, infection, hematoma, delayed wound healing, prolonged hospitalization, and increased treatment costs. Based on those mentioned above, this study aims to determine the role of Latissimus Dorsi (LD) flap on seroma for postsurgical Modified Radical Mastectomy (MRM) Locally Advanced Breast Cancer (LABC) patients
It can be concluded that there is a difference in the mean of total seroma in LABC patients with MRM with and without LD flap

Summary

Introduction

Advanced Breast Cancer (LABC) is defined as breast cancer spread in locoregional but does not spread beyond the breast and regional lymph nodes.[1]. Seroma is defined as a serous fluid formed after surgery, under the skin flap, and collected in the dead space.[6] Several hypotheses stated that surgery disrupts the lymphatic channels, resulting in a collection of fluid, which is seroma This hypothesis is supported by a study that said latissimus dorsi (LD) flap has a higher risk of seroma formation than without LD flap.[7] The accumulation of seroma fluid increases and lifts from the lining of the chest wall and axillary to the tissue.[8] Seroma can make the patient anxious, causes discomfort, and disrupt wound healing. Conclusion: Seroma production is significantly higher in LABC patients post MRM without LD flap reconstruction than LABC patients with LD flap

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