Importance of Nutrition in the development of Seroma after Breast Surgery

Abstract

Amaç: Meme cerrahisi sonrası seroma gelişiminde nütrisyonun önemini araştırmak. Seroma mastektomi sonrası görülen en sık komplikasyon olup, görülme sıklığı %10- 50 arasında değişmektedir. Seroma cilt nekrozu, enfeksiyon, yara iyileşmesini gecikmesi ve bunun sonucu olarak ek tedavilerin gecikmesine neden olabileceği için ciddiye alınması gereken bir komplikasyondur. Metod: Bu deneysel çalışmada 10’arlı gruplara ayrılan toplan 40 rat kullanıldı. Preoperatif 7 gün boyunca 1.gruba (kontrol) normal rat gıdası, 2. gruba kontrol grubunun %70’i kadar normal rat gıdası (malnütrisyon), 3. ve 4. gruba proteinden zengin diyet (Glutamin-Arjinin-Metil Bütirat) (10gr protein /kg/gün) verildi ve gruplara 7. gün tek taraflı (sağ) pektoral majör kas eksizyonu ve aksiler diseksiyon uygulandı. Postoperatif 10 gün boyunca 1. gruba normal rat gıdası, 2. gruba kontrol grubunun %70’ i kadar normal rat gıdası, 3. gruba normal rat gıdası ve 4. gruba proteinden zengin diyet verildi. Postoperatif 10. günde ratlardan seroma örneği alınarak sakrifiye edildi. Bulgular: Kontrol grubunun seroma miktarı 1,5 ml (1ml-2,5ml), malnütrüsyon grubunun seroma miktarı 1,5ml (1ml-2,75ml), preoperatif proteinden zengin diyetle beslenen 3.grubun seroma miktarı 1ml (0,5ml-1ml), preoperatif ve postoperatif proteinden zengin diyetle beslenen 4.grubun seroma miktarı 0,75ml (0,5ml-1ml) olarak bulundu. Seroma miktarları ortanca olarak verildi. Bu değerlere göre proteinden zengin diyetle beslenen grupların seroma miktarları anlamlı olarak düşük bulundu. (p=0,001 ) Sonuç: Çalışmamızda elde edilen veriler doğrultusunda deneysel mastektomi ve aksiller diseksiyon (AD) modelinde preoperatif ve postoperatif dönemde proteinden yüksek diyetle beslenmenin seroma oluşumunu azalttığı görülmüştür. Benzer şekilde klinik çalışmaların planlanması gerektiği kanaatindeyiz.

Keywords

• Seroma
• nutrition
• breast surgery
• experimental rat model
• protein rich diet

References

1. J.A. McCaul, A. Aslaam, R. J. Spooner, I.Louden, T. Cavanagh, A. D. Purushotham. Aetiology of seroma formation in patients undergoing surgery for breast cancer. The Breast 2000;9:144-148. PMID: 14731838
2. Ernest A. Gonzalez, MD, Edward C. Saltzstein, MD, Carola S. Riedner, MD, Brian K. Nelson, MD. Seroma Formation Following Breast Cancer Surgery. The Breast Journal 2003;9(5):385-388. PMID: 12968958
3. Esmat Hashemi, Ahmad Kaviani, Masoume Najafi, Mandana Ebrahimi, Homeira Hooshmand, Ali Montazeri. Seroma formation after surgery for breast cancer. World J Surg Oncol. 2004;2:44. PMID: 15588301
4. Katsumasa Kuroi, Kojiro shimozuma, Tetsuya Taguchi, Hirohisa Imai, Hiroyasu Yamashiro, Shozo Ohsumi, Shinya Saito. Pathophysiology of Seroma in Breast Cancer. Breast Cancer 2005; 12(4):288-293. PMID: 16286909
5. C. J. Pogson, A. Adwani and S. R. Ebbs. Seroma following breast cancer surgery. European Journal of Surgical Oncology 2003;29:711-717. PMID: 14602488
6. Turner EJ1, Benson JR, Winters ZE. Techniques in the prevention and management of seromas after breast surgery. Future Oncol. 2014 May;10(6):1049-63. PMID: 24941989
7. Chung TL1, Holton LH 3rd, Goldberg NH, Silverman RP. Seroma prevention using Mytilus edulis protein in a rat mastectomy model. Breast J. 2006 Sep-Oct;12(5):442-5. PMID: 16958963
8. E.Tekin, M. A. Kocdor, S. Saydam, S. Bora, O. Harmancioğlu. Seroma Prevention by Using Corynebacterium parvum in a Rat Mastektomi Model. Eur Surg Res 2001;33:245- 248. PMID: 11490129

9. Katsumasa Kuroi, Kojiro Shimozuma, Tetsuya Taguchi, Hirohisa Imai, Hiroyasu Yamashiro, Shozo Ohsumi, Shinya Saito. Evidence –Based Risk Factors for seroma formation in Breast Surgery. Jpn J Clin Oncol 2006;36(4):197-206. PMID: 16684859
10. William E. Stehbens. Postmastectomy serous drainage and seroma: probable pathogenesis and prevention. ANZ J. Surg. 2003;73:877-880. PMID: 14616557
11. Oertli D1, Laffer U, Haberthuer F, Kreuter U, Harder F. Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer. Br. J. Surg. 1994; 81: 856–9. PMID: 8044602
12. Vaxman F1, Kolbe A, Stricher F, Zund D, Volkmar P, Gros D, Grenier JF. Does fibrin glue improve drainage after axillary lymph node dissection? Prospective and randomized clinical study in humans. Eur Surg Res 1995; 27: 346-352. PMID: 7589007
13. Petrek JA1, Peters MM, Nori S, Knauer C, Kinne DW, Rogatko A. Axillary lymphadenectomy. A prospective, randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization. Arch. Surg. 1990; 125: 378–82. PMID: 2407228
14. Gonzalez EA1, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast J. 2003; 9: 385–8. PMID: 12968958
15. Hashemi E1, Kaviani A, Najafi M, Ebrahimi M, Hooshmand H, Montazeri A. Seroma formation after surgery for breast cancer. World J. Surg. Oncol. 2004; 2: 44. PMID: 15588301
16. Rice DC1, Morris SM, Sarr MG, Farnell MB, van Heerden JA, Grant CS, Rowland CM, Ilstrup DM, Donohue JH. İntraoperative topical tetracycline sclerotherapy following mastectomy, a prospective randomized trial. J Surg Oncol 2000;73:224-227. PMID: 10797336
17. O'Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg. 1999 Jun;177(6):450-3. PMID: 10414691
18. Rajkumar Kottayasamy Seenivasagam, Vikas Gupta, Gurpreet Singh. Preventıon of seroma formatıon after axıllary dıssectıon--a comparatıve randomızed clınıcal trıal of three methods. Breast J 2013 Sep-Oct;19(5):478-84. Epub 2013 Jul 19. PMID: 23865902
19. Parikh HK1, Badwe RA, Ash CM, Hamed H, Freitas R Jr, Chaudary MA, Fentiman IS. Early drain removal following modified radical mastectomy: a randomised trial. J Surg Oncol 1992; 51: 266-269. PMID: 1434659
20. Purushotham AD1, McLatchie E, Young D, George WD, Stallard S, Doughty J, Brown DC, Farish C, Walker A, Millar K, Murray G. Randomised clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg 2002; 89: 286-292. PMID: 11872051
21. Coveney EC1, O'Dwyer PJ, Geraghty JG, O'Higgins NJ. Effect of closing dead space on seroma formation after mastectomy: a prospective randomised cilnical trial. Eur J Surg Oncol 1993; 19; 143-146. PMID: 8491318
22. Watt-Boolsen S1, Nielsen VB, Jensen J, Bak S. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan. Med. Bull. 1989; 36: 487–9. PMID: 2509147
23. Wang JY1, Goodman NC, Amiss LR Jr, Nguyen DH, Rodeheaver GT, Moore MM, Morgan RF, Abbott RD, Spotnitz WD. Seroma prevention in a rat mastectomy model: use of a light-activated fibrin sealant. Ann Plast Surg. 1996,37:400-405. PMID: 8905048
24. Styblo TM1, Wood WC. Adjuvant chemotherapy in the node-negative breast cancer patient. The Surg Clin Nor Am, 1996:327-343. PMID: 8610267
25. Budd DC, Cochran RC, Sturtz DL, Fouty WJ Jr.. Surgical morbidity after mastectomy operations. Am. J. Surg. 1978; 135: 218–20. PMID: 626296
26. Gerstein AD1, Phillips TJ, Rogers GS, Gilchrest BA. Wound healing and aging. Dermatol Clin. 1993 Oct;11(4):749-57. PMID: 8222358
27. Barbul A, Purtill WA Nutrition in wound healing. Clin Dermatol. 1994; 12:133. PMID: 8180936