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Stangel-Wójcikiewicz K, Murawski M, Schwarz T, Skotniczny K, Fuchs A, Wolski J, Radwan-Pragłowska J, Janus Ł, Piątkowski M, Kot M, Wróbel A, Wojtysiak D, Urbaniec P. Pelvic Organ Prolapse Reconstruction with the Chitosan-Based Novel Haemostatic Agent in Ovine Model-Preliminary Report. Int J Mol Sci 2024; 25:3801. [PMID: 38612610 PMCID: PMC11011902 DOI: 10.3390/ijms25073801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
This prospective study aimed to assess the feasibility of chitosan biomaterial and subcutaneous gel implantation in an ovine model, with implications for women with genital prolapse. Twenty-four ewes were divided into four groups (n = 6 per group): chitosan type B, chitosan type C, chitosan unmodified injections, and polypropylene mesh. Ovine models were chosen due to their morphological resemblance to human reproductive organs. Animals were sacrificed after 90 days for macroscopic, pathomorphological, and immunohistochemical analysis. In the chitosan type B group, IL-6 and IL-10 levels decreased after 28 days, while chitosan type C and injection groups exhibited higher IL-6 than IL-10 levels. The polypropylene group displayed the highest IL-6 and lowest IL-10 levels. Histological examination of the polypropylene group revealed no degenerative changes or inflammation, whereas chitosan injection induced local inflammation. Other groups exhibited no degenerative changes. Ewes implanted with chitosan displayed reduced inflammation compared to polypropylene-implanted ewes. Chitosan implantation facilitated vaginal tissue healing, in contrast to polypropylene mesh, which led to extrusion. While chitosan holds promise as an alternative to polypropylene mesh, further research is imperative for comprehensive evaluation. This study suggests the potential of a chitosan biomaterial in pelvic organ prolapse treatment, warranting additional investigation.
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Affiliation(s)
- Klaudia Stangel-Wójcikiewicz
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Maciej Murawski
- Department of Animal Nutrition, Biotechnology and Fisheries, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland;
| | - Tomasz Schwarz
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
| | - Krzysztof Skotniczny
- Department of Gynecology and Oncology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (K.S.-W.); (K.S.)
| | - Agnieszka Fuchs
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Jan Wolski
- Department of Gynecological Endocrinology and Gynecology, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 23, 31-501 Kraków, Poland; (A.F.); (J.W.)
| | - Julia Radwan-Pragłowska
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Łukasz Janus
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marek Piątkowski
- Department of Biotechnology and Physical Chemistry, Faculty of Chemical Engineering and Technology, Cracow University of Technology, ul. Warszawska 24, 31-155 Kraków, Poland; (Ł.J.); (M.P.)
| | - Marta Kot
- Department of Transplantation, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, ul. Wielicka 265, 30-663 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-090 Lublin, Poland;
| | - Dorota Wojtysiak
- Department of Genetics, Animal Breeding and Ethology, Faculty of Animal Science, University of Agriculture in Kraków, ul. Mickiewicza 21, 31-120 Kraków, Poland; (T.S.); (D.W.)
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Liu J, Yin J, Yin J, Zhou M, Chen L, Dong X, Li Y. Effect of esketamine-based opioid-sparing anesthesia strategy on postoperative pain and recovery quality in patients undergoing total laparoscopic hysterectomy: A randomized controlled trail. Heliyon 2024; 10:e24941. [PMID: 38317936 PMCID: PMC10839621 DOI: 10.1016/j.heliyon.2024.e24941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Objective Opioid-sparing anesthesia reduces intraoperative use of opioids and postoperative adverse reactions. The current study investigated the effect of esketamine-based opioid-sparing anesthesia on total laparoscopic hysterectomy patients' recovery. Methods Ninety patients undergoing total laparoscopic hysterectomy were randomly assigned to esketamine-based group (group K) or opioid-based group (group C). The allocation to groups was unknown to patients, surgeons, and postoperative medical staff. The inability to implement blinding for anesthesiologists was due to the distinct procedures followed by the various groups while administering drugs. The QoR-40 and VAS were used to measure recovery quality. Postoperative adverse events, perioperative opioid consumption, and intraoperative hemodynamics were secondary endpoints. Results There was an absence of notable discrepancy in the baseline data observed between the two groups. The QoR-40 scores exhibited greater values in group K when compared to group C on the first day following the surgical procedure (160.91 ± 9.11 vs 151.47 ± 8.35, respectively; mean difference 9.44 [95 %CI: 5.78-13.11]; P < 0.01). Within 24 h of surgery, the VAS score of group K was lower at rest and during movement. (P < 0.05 for each). Group K had much lower rates of nausea and vomiting within 24 h of surgery. (P < 0.05 for each). Group K received significantly lower total doses of sufentanil and remifentanil than group C. (17.28 ± 2.59 vs 43.43 ± 3.52; 0.51 ± 0.15 vs 1.24 ± 0.24). The proportion of patients who used ephedrine in surgery was higher in group C than in group K (P < 0.05). Conclusions Esketamine-based opioid-sparing anesthesia strategy is feasible and enhanced recuperation following surgery by decreasing adverse effects associated with opioids and pain scores compared to an opioid-based anesthetic regimen.
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Affiliation(s)
- Jialei Liu
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
- Department of Anesthesiology, Suzhou First People's Hospital, Suzhou, China
| | - Jiangwen Yin
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Jieting Yin
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Menghan Zhou
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Long Chen
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Xiwei Dong
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
| | - Yan Li
- Department of Anesthesiology, First Affiliated Hospital of Shihezi University, Shihezi, China
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Feng S, Li Z, Liu M, Ye Q, Xue T, Yan B. Postoperative serum interleukin-6 levels correlate with survival in stage I-III colorectal cancer. BMC Gastroenterol 2023; 23:156. [PMID: 37194025 DOI: 10.1186/s12876-023-02800-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
AIMS The preoperative serum levels of inflammatory mediators, including C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), have been demonstrated to be correlated with patient outcomes in colorectal cancer (CRC); however, the prognostic role of these levels has been less well-studied in postoperative settings. MATERIALS AND METHODS A total of 122 stage I-III CRC patients were retrospectively enrolled. Serum levels of CRP, PCT and IL-6 were measured after surgery, and their prognostic value was evaluated. Kaplan-Meier analysis was used to determine the differences in disease-free survival (DFS) and overall survival (OS) between patients with different levels of these mediators, and the Cox proportional hazards model was used to estimate the risk factors. RESULTS In contrast to CRP and PCT, only the level of IL-6 was significant in predicting DFS (P = 0.01) but not OS (P = 0.07). A total of 66.39% (81/122) of patients were assigned to the low IL-6 group and no significant differences were found in the collected clinicopathological parameters among the low or high IL-6 subgroups. The level of IL-6 was negatively correlated with postoperative (1 w) (R=-0.24, P = 0.02) absolute lymphocyte counts. Patients with low levels of IL-6 had better DFS (log rank = 6.10, P = 0.01) but not OS (log rank = 2.28, P = 0.13). Finally, the level of IL-6 was an independent risk factor for DFS (HR: 1.81, 95% CI: 1.03-3.15, P = 0.04). CONCLUSIONS Compared to CRP and PCT, the level of IL-6 was observed to be the only significant factor in predicting the prognosis of stage I-III CRC patients after surgery, and a low level of IL-6 was associated with good DFS.
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Affiliation(s)
- Shouhan Feng
- Department of Oncology, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou city of Zhejiang Province, 313000, P.R. China
| | - Zeshi Li
- Department of Critical Care Medicine, Hainan Hospital of PLA General Hospital, Sanya city of Hainan province, 572000, P.R. China
| | - Mei Liu
- Department of Tumor Chemotherapy, Haikou People's Hospital, Haikou city of Hainan province, 570208, P.R. China
| | - Qianwen Ye
- Department of Oncology, Hainan Hospital of PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya city, Hainan province, 572000, P.R. China
| | - Tianhui Xue
- Department of Oncology, Hainan Hospital of PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya city, Hainan province, 572000, P.R. China
| | - Bing Yan
- Department of Oncology, Hainan Hospital of PLA General Hospital, No. 80 of Jianglin Road, Haitang District of Sanya city, Hainan province, 572000, P.R. China.
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Li R, Mukherjee MB, Jin Z, Liu H, Lin K, Liu Q, Dilger JP, Lin J. The Potential Effect of General Anesthetics in Cancer Surgery: Meta-Analysis of Postoperative Metastasis and Inflammatory Cytokines. Cancers (Basel) 2023; 15:2759. [PMID: 37345096 DOI: 10.3390/cancers15102759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Metastasis or recurrence following curative surgery is the main indicator of tumor progress and is the main cause of patient death. For more than three decades, the potential for general anesthesia to affect cancer outcomes has been a subject of concern with considerable research interest. Here, we conducted this systematic review and meta-analysis to summarize the effect of inhalational anesthesia (IHNA) vs. propofol-based total intravenous anesthesia (TIVA) on metastasis and recurrence after cancer surgery from clinical and pre-clinical studies. The relative risk for metastasis/recurrence in TIVA is 0.61 (95% confidence interval (95% CI) 0.46 to 0.82, p = 0.0009) compared to IHNA. Inflammatory cytokines have been implicated in cancer metastasis following cancer surgery, thus we analyzed inflammatory cytokines levels after surgery under IHNA or TIVA. Based on pooled analysis, a lower IL-6 level was noticed in TIVA in comparison to IHNA (standardized mean difference (SMD) = 0.77, 95% CI = 0.097 to 1.44, I2 = 92%, p = 0.02) but not TNF-α or IL-10. Preclinical animal model studies show that inhalational anesthetics increase the risk of breast cancer metastasis compared to propofol. In conclusion, the current evidence suggests intravenous anesthetic propofol is associated with less metastasis/recurrence and lower postoperative IL-6 level over inhaled anesthetics in the oncological surgery. We urge more well-designed clinical and preclinical studies in this field.
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Affiliation(s)
- Ru Li
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Mousumi Beto Mukherjee
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Hengrui Liu
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Kevin Lin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Qiuyue Liu
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - James P Dilger
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794-8480, USA
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Santander Ballestín S, Lanuza Bardaji A, Marco Continente C, Luesma Bartolomé MJ. Antitumor Anesthetic Strategy in the Perioperatory Period of the Oncological Patient: A Review. Front Med (Lausanne) 2022; 9:799355. [PMID: 35252243 PMCID: PMC8894666 DOI: 10.3389/fmed.2022.799355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
The stress response triggered by the surgical aggression and the transient immunosuppression produced by anesthetic agents stimulate the inadvertent dispersion of neoplastic cells and, paradoxically, tumor progression during the perioperative period. Anesthetic agents and techniques, in relation to metastatic development, are investigated for their impact on long-term survival. Scientific evidence indicates that inhaled anesthetics and opioids benefit immunosuppression, cell proliferation, and angiogenesis, providing the ideal microenvironment for tumor progression. The likely benefit of reducing their use, or even replacing them as much as possible with anesthetic techniques that protect patients from the metastatic process, is still being investigated. The possibility of using "immunoprotective" or "antitumor" anesthetic techniques would represent a turning point in clinical practice. Through understanding of pharmacological mechanisms of anesthetics and their effects on tumor cells, new perioperative approaches emerge with the aim of halting and controlling metastatic development. Epidural anesthesia and propofol have been shown to maintain immune activity and reduce catecholaminergic and inflammatory responses, considering the protective techniques against tumor spread. The current data generate hypotheses about the influence of anesthesia on metastatic development, although prospective trials that determinate causality are necessary to make changes in clinical practice.
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Affiliation(s)
- Sonia Santander Ballestín
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
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Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis. Cancers (Basel) 2021; 14:cancers14010161. [PMID: 35008324 PMCID: PMC8750535 DOI: 10.3390/cancers14010161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/11/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Colorectal cancer is the second most common cancer worldwide, and the incidence increases with age. The primary treatment for localized disease is surgical resection. Biomarkers identifying older patients at risk of complications following surgery are desirable to create a more individualized treatment plan. The purpose of this study is to investigate if circulating proteins related to inflammation (CRP, Il-6, and YKL-40) can provide information about the risk of complications and survival in older patients undergoing resection, and, furthermore, to investigate if this relation is different in older patients as compared to younger patients. We investigated 401 patients with localized colorectal cancer and found that older patients (n = 210) had higher levels of preoperative inflammatory biomarkers compared to younger patients (n = 191). High levels were associated with major complications after resection in older, but not in younger, patients. This may be useful in the future to design more personalized treatment plans. Abstract The association between pre- and perioperative inflammatory biomarkers, major complications, and survival rates after resection of colorectal cancer (CRC) in older patients is largely unknown. The aim was to investigate age-dependent differences in these associations. Serum CRP, IL-6, and YKL-40 were measured preoperatively and on the first and second day after resection of CRC (stages I–III) in 210 older (≥70 years) and 191 younger patients (<70 years). The results from the complications was presented as an odds ratio (OR, with a 95% confidence interval (CI)) with logistic regression. Results from the mortality rates were presented as a hazard ratio (HR, with a 95% CI) using Cox proportional hazards regression. The preoperative inflammatory biomarkers were higher in the older vs. the younger patients. The risk of complications was increased in older patients with a high preoperative CRP (OR = 1.25, 95% CI 1.03–1.53), IL-6 (OR = 1.57, 95% CI 1.18–2.08), and YKL-40 (OR = 1.66, 95% CI 1.20–2.28), but not in younger patients. Mortality was higher in younger patients with high preoperative YKL-40 (HR = 1.66, 95% CI 1.06–2.60). This was not found in older patients. Elevated preoperative inflammatory biomarkers among older patients were associated with an increased risk of complications, but not mortality. Preoperative inflammatory biomarkers may be useful in assessing the risk of a complicated surgical course in older patients with CRC.
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Saha P, Das A, Chatterjee N, Chakrabarti D, Sinha D. Impact of anesthetics on oncogenic signaling network: a review on propofol and isoflurane. Fundam Clin Pharmacol 2021; 36:49-71. [PMID: 34655261 DOI: 10.1111/fcp.12732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
Propofol as an intravenous anesthetic and isoflurane as an inhalational/volatile anesthetic continue to be an important part of surgical anesthetic interventions worldwide. The impact of these anesthetics on tumor progression, immune modulation, and survival rates of cancer patients has been widely investigated. Although most of the preclinical studies have provided a beneficial effect of propofol over isoflurane or other volatile anesthetics, several investigations have shown contradictory results, which warrant more preclinical and clinical studies. Propofol mostly exhibits antitumor properties, whereas isoflurane being a cost-effective anesthetic is frequently used. However, isoflurane has been also reported with protumorigenic activity. This review provides an overall perspective on the network of signaling pathways that may modulate several steps of tumor progression from inflammation, immunomodulation, epithelial-mesenchymal transition (EMT) to invasion, metastasis, angiogenesis, and cancer stemness and extracellular vesicles along with chemotherapeutic applications and clinical status of these anesthetics. A clear understanding of the mechanistic viewpoints of these anesthetics may pave the way for more prospective clinical trials with the ultimate goal of obtaining a safe and optimal anesthetic intervention that would prevent cancer recurrence and may influence better postoperative survival.
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Affiliation(s)
- Priyanka Saha
- Department of Receptor Biology and Tumor Metastasis, Chittaranjan National Cancer Institute, Kolkata, India
| | - Ananya Das
- Department of Receptor Biology and Tumor Metastasis, Chittaranjan National Cancer Institute, Kolkata, India
| | - Nabanita Chatterjee
- Department of Receptor Biology and Tumor Metastasis, Chittaranjan National Cancer Institute, Kolkata, India
| | - Deepa Chakrabarti
- Department of Anesthesiology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Dona Sinha
- Department of Receptor Biology and Tumor Metastasis, Chittaranjan National Cancer Institute, Kolkata, India
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Xu Y, Jiang W, Xie S, Xue F, Zhu X. The Role of Inhaled Anesthetics in Tumorigenesis and Tumor Immunity. Cancer Manag Res 2020; 12:1601-1609. [PMID: 32184663 PMCID: PMC7061426 DOI: 10.2147/cmar.s244280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022] Open
Abstract
Inhaled anesthetics are widely used for induction and maintenance of anesthesia during surgery, including isoflurane, sevoflurane, desflurane, haloflurane, nitrous oxide (N2O), enflurane and xenon. Nowadays, it is controversial whether inhaled anesthetics may influence the tumor progression, which urges us to describe the roles of different inhaled anesthetics in human cancers. In the review, the relationships among the diverse inhaled anesthetics and patient outcomes, immune response and cancer cell biology were discussed. Moreover, the mechanisms of various inhaled anesthetics in the promotion or inhibition of carcinogenesis were also reviewed. In summary, we concluded that several inhaled anesthetics have different immune functions, clinical outcomes and cancer cell biology, which could contribute to opening new avenues for selecting suitable inhaled anesthetics in cancer surgery.
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Affiliation(s)
- Yichi Xu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenxiao Jiang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Shangdan Xie
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fang Xue
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Alhayyan A, McSorley S, Roxburgh C, Kearns R, Horgan P, McMillan D. The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surg Open Sci 2020; 2:1-21. [PMID: 32754703 PMCID: PMC7391900 DOI: 10.1016/j.sopen.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. METHODS This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. RESULTS Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12-24 and 24-72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein (P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. CONCLUSION There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.
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Affiliation(s)
- Aliah Alhayyan
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Stephen McSorley
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Campbell Roxburgh
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Department of Anaesthetics, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Paul Horgan
- Institute of Cancer Sciences, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Donald McMillan
- Institute of Cancer Sciences, Department of Surgery, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
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Abstract
Abstract
EDITOR’S PERSPECTIVE
What We Know about This Topic
IV anesthesia may impair anticancer immunity less than volatile anesthesia and therefore reduce recurrence risk
What This Article Tells Us That Is New
In a large propensity-matched retrospective cohort analysis, the authors compared total IV and volatile anesthesia for breast cancer surgery
Recurrence hazard was similar with each approach
Selection of IV or volatile anesthesia should be based on factors other than cancer recurrence
Background
The association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery.
Methods
The authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan–Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia.
Results
Of 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan–Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia.
Conclusions
The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.
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Berger M, Ponnusamy V, Greene N, Cooter M, Nadler JW, Friedman A, McDonagh DL, Laskowitz DT, Newman MF, Shaw LM, Warner DS, Mathew JP, James ML. The Effect of Propofol vs. Isoflurane Anesthesia on Postoperative Changes in Cerebrospinal Fluid Cytokine Levels: Results from a Randomized Trial. Front Immunol 2017; 8:1528. [PMID: 29181002 PMCID: PMC5694037 DOI: 10.3389/fimmu.2017.01528] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/27/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction Aside from direct effects on neurotransmission, inhaled and intravenous anesthetics have immunomodulatory properties. In vitro and mouse model studies suggest that propofol inhibits, while isoflurane increases, neuroinflammation. If these findings translate to humans, they could be clinically important since neuroinflammation has detrimental effects on neurocognitive function in numerous disease states. Materials and methods To examine whether propofol and isoflurane differentially modulate neuroinflammation in humans, cytokines were measured in a secondary analysis of cerebrospinal fluid (CSF) samples from patients prospectively randomized to receive anesthetic maintenance with propofol vs. isoflurane (registered with http://www.clinicaltrials.gov, identifier NCT01640275). We measured CSF levels of EGF, eotaxin, G-CSF, GM-CSF, IFN-α2, IL-1RA, IL-6, IL-7, IL-8, IL-10, IP-10, MCP-1, MIP-1α, MIP-1β, and TNF-α before and 24 h after intracranial surgery in these study patients. Results After Bonferroni correction for multiple comparisons, we found significant increases from before to 24 h after surgery in G-CSF, IL-10, IL-1RA, IL-6, IL-8, IP-10, MCP-1, MIP-1α, MIP-1β, and TNF-α. However, we found no difference in cytokine levels at baseline or 24 h after surgery between propofol- (n = 19) and isoflurane-treated (n = 21) patients (p > 0.05 for all comparisons). Increases in CSF IL-6, IL-8, IP-10, and MCP-1 levels directly correlated with each other and with postoperative CSF elevations in tau, a neural injury biomarker. We observed CSF cytokine increases up to 10-fold higher after intracranial surgery than previously reported after other types of surgery. Discussion These data clarify the magnitude of neuroinflammation after intracranial surgery, and raise the possibility that a coordinated neuroinflammatory response may play a role in neural injury after surgery.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Vikram Ponnusamy
- University of Missouri School of Medicine, Columbia, MO, United States
| | - Nathaniel Greene
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Mary Cooter
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Jacob W Nadler
- Neurosurgical Anesthesiology, Postanesthesia Care Unit, Department of Anesthesiology, University of Rochester, Rochester, NY, United States
| | - Allan Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, United States
| | - David L McDonagh
- Department of Anesthesiology & Pain Management, Neurological Surgery, Neurology and Neurotherapeutics, University of Texas, Southwestern, Dallas, TX, United States
| | - Daniel T Laskowitz
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.,Department of Neurology, Duke University Medical Center, Durham, NC, United States.,Department of Neurobiology, Duke University Medical Center, Durham, NC, United States
| | - Mark F Newman
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.,Private Diagnostic Clinic, Duke University Medical Center, Durham, NC, United States
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David S Warner
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.,Department of Neurobiology, Duke University Medical Center, Durham, NC, United States.,Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Michael L James
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.,Department of Neurology, Duke University Medical Center, Durham, NC, United States
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de la Gala F, Piñeiro P, Reyes A, Vara E, Olmedilla L, Cruz P, Garutti I. Postoperative pulmonary complications, pulmonary and systemic inflammatory responses after lung resection surgery with prolonged one-lung ventilation. Randomized controlled trial comparing intravenous and inhalational anaesthesia. Br J Anaesth 2017; 119:655-663. [DOI: 10.1093/bja/aex230] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/14/2022] Open
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An Update on Existing Ongoing Prospective Trials Evaluating the Effect of Anesthetic and Analgesic Techniques During Primary Cancer Surgery on Cancer Recurrence or Metastasis. Int Anesthesiol Clin 2016; 54:e76-83. [DOI: 10.1097/aia.0000000000000123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Reply to: Influence of total intravenous anaesthesia and isoflurane on plasma interleukin concentrations after colorectal cancer surgery. Eur J Anaesthesiol 2015; 32:283-4. [PMID: 25603390 DOI: 10.1097/eja.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Influence of total intravenous anaesthesia and isoflurane on plasma interleukin concentrations after colorectal cancer surgery. Eur J Anaesthesiol 2015; 32:281-2. [PMID: 25603384 DOI: 10.1097/eja.0000000000000211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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