Abstract
BackgroundSurgery/anesthetic technique-stimulated immunosuppression may be associated with outcome for cancer patients. Here, the immune responses of patients undergoing day surgery versus hospitalization surgery for breast cancer were compared in a prospective study.MethodsBetween February 2012 and August 2014, 21 breast cancer patients underwent day surgery and 16 breast cancer patients underwent hospitalization surgery. The former group received lidocaine/propofol/pethidine, while propofol/systemic opioid- and sevoflurane/propofol/systemic opioid-based anesthesia were administered to the latter group. Surgical stress response was evaluated based on time of operation and amount of bleeding during operation. Immune function was assessed based on natural killer (NK) cell activity, CD4/8 T cell ratio, and cytokine levels of IL-6 and IL-10 that were detected before surgery, after surgery, and on the first postoperative day.ResultsOperation time did not differ between the two groups. Blood loss was significantly less for the hospitalization surgery group. No change in NK cell activity was observed for either group, although the CD4/8 T cell ratio increased transiently following day surgery. Levels of IL-6 increased significantly in both groups following surgery, and these levels tended to be higher in the hospitalization surgery group. One patient who underwent hospitalization surgery had higher levels of IL-10.ConclusionsThere were few differences in immune response between the two groups, potentially since a majority of the hospitalization surgery patients received propofol-based anesthesia. We hypothesize that the use of volatile anesthetic/opioid analgesia in hospitalization surgery has a greater influence on immune function in breast cancer patients than local anesthetic/propofol-based anesthesia in day surgery.
Highlights
Surgery/anesthetic technique-stimulated immunosuppression may be associated with outcome for cancer patients
We wanted to investigate whether the use of local anesthetics in combination with anesthetic sedation can result in decreased cancer recurrence
Immune function was evaluated in this preliminary and prospectively designed study that included a small sample of breast cancer patients who received local anesthetic/anesthetic sedation for day surgery versus general anesthesia (GA) for hospitalization surgery
Summary
Surgery/anesthetic technique-stimulated immunosuppression may be associated with outcome for cancer patients. The relationship between anesthetic technique and cancer recurrence has been a major topic in oncologic surgery. The rationale for this discussion is based on the observation that volatile anesthetics. A retrospective study showed that patient outcome in those receiving paravertebral or epidural anesthesia combined with GA was superior to that of those receiving GA/opioid analgesia [9]. Based on these data, a prospective randomized controlled trial (RCT) is currently underway to provide more definitive and conclusive evidence of anesthetic technique on cancer recurrence [10]
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