Dr Sumbal Nayab, Dr Kiran Sarfraz, Dr Hafiza Seerat E Amna
Background: Surgical treatment of breast cancer has changed radically from radical surgery to breast conserving technique. The most common complications of conventional modified radical mastectomy with axillary dissection, electrocoagulation (diathermy), and suture ligation are serous, lymphoedema with a frequency of 11% to 85% and 2% to 50%, respectively Purpose: The study was conducted to assess feasibility, safety and efficacy modified radical mastectomy with axillary preparation with a harmonic scalpel in terms of time of operation, sealing of lymphatic vessels, hemostasis and postoperative complications. Place and Duration: This prospective observational study was conducted in the Surgical department of Holy Family Hospital, Rawalpindi for one-year duration from March 2019 to March 2020. Methodology: During this period, a total of 60 patients underwent a modified radical mastectomy and axillary removal. The study included patients with indications for modified radical mastectomy and ASA (American Society of Anesthesia) with a result of 1 and 2. The study group excluded patients with early breast cancer (T1), after breast surgery, neoadjuvant surgery, a patient with diabetes and other diseases coexisting. Results: All data were entered and analyzed in SPSS 17. Descriptive statistics were used to summarize continuous variables and presented as mean ± standard deviation and categorical variables in frequencies and percentages because it is an observational study, no statistical test and p-value are required. The mean intraoperative blood loss was 45 ± 12 ml, and the mean operative time was 90 ± 7 minutes. There was no postoperative bleeding or hematoma. But on the other hand, there was seroma (2), lymphedema, and wound infection. The mean volume of flap and axillary drainage was 20 ± 8 ml and 155 ± 35 ml, respectively, and the mean drainage time was 1.3 ± 0.2 and 2.7 ± 0.5 days, respectively. The mean stay in hospital was 3.7 ± 0.6 days. Of the 60 patients, 19 (31.6%) patients had positive axillary nodes, of which 6 patients (10%) had 1-2 positive lymph nodes and 13 patients (21.6%) had four or more positive lymph nodes. Conclusion: The modified radical mastectomy and axillary preparation using a harmonic scalpel was safe, feasible and effective. This device simplifies surgery, surgery time, perioperative blood loss, drainage volume and drainage time. In addition, the incidence of seroma and lymphoedema also decreased. Key words: modified radical mastectomy, harmonic scalpel, seroma.