Does the use of perioperative corticosteroids reduce the incidence of seroma formation after breast cancer surgery? A systematic review and meta-analysis

BACKGROUND:
Seroma is a common complication of breast cancer surgery, affecting up to 85% of cases.


OBJECTIVE:
To assess the effectiveness of perioperative corticosteroids in reducing seroma formation.


DESIGN:
Systematic review and meta-analysis of published literature from PubMed, Ovid, Google Scholar, and Web of Science databases.


METHODS:
A systematic search identified randomized controlled trials (RCTs) on corticosteroids in breast cancer surgery. Data were pooled using a random-effects model. Subgroup analyses were performed by corticosteroid type, timing, and route. Risk of bias (RoB) was assessed using the Cochrane Collaboration's RoB Tool for RCTs. Articles were collected from inception to August 2024. Inclusion criteria: RCTs and observational studies evaluating perioperative corticosteroids in breast cancer surgery. Exclusion criteria: non-breast surgery populations and absence of seroma outcome data.


MAIN OUTCOMES MEASURES:
Incidence of postoperative seroma


SAMPLE SIZE:
Seven RCTs involving 689 patients were included.


RESULTS:

Pooled analysis using random-effects model demonstrated that corticosteroids reduced seroma risk (OR: 0.31, 95% CI: 0.20–0.48). Hydrocortisone was more effective than methylprednisolone (OR: 0.14 vs. 0.41;
P
=.0155). Heterogeneity was low (I²=17.3%).



RISK OF BIAS:

Publication bias assessment using Duval and Tweedie method identified three hypothetically missing studies; adjusted pooled estimate: OR 0.42 (95% CI: 0.28–0.63,
P
<.001).



CONCLUSION:
Corticosteroids, especially hydrocortisone, appears to be effective in reducing seroma formation.


LIMITATIONS:
Small sample size, protocol variability, and moderate publication bias as evidenced by funnel plot asymmetry and heterogeneity in timing subgroups (I²=48.1%).


REGISTRATION NO:
CRD42024590767.