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Ao L, Shi J, Gan J, Yu W, Du H. Effects of dexmedetomidine and ketorolac applied for patient‑controlled analgesia on the balance of Th1/Th2 and level of VEGF in patients undergoing laparoscopic surgery for cervical cancer: A randomized controlled trial. Oncol Lett 2024; 28:379. [PMID: 38939623 PMCID: PMC11209859 DOI: 10.3892/ol.2024.14512] [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: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 06/29/2024] Open
Abstract
The aim of the present study was to explore the effects of dexmedetomidine (DEX) combined with ketorolac on postoperative patient-controlled analgesia (PCA), the balance of Th1/Th2 and the level of vascular endothelial growth factor (VEGF) in patients with cervical cancer following laparoscopic radical surgery. A total of 70 women with cervical cancer undergoing laparoscopic radical hysterectomy were enrolled in the study to randomly receive postoperative dexmedetomidine combined with ketorolac analgesia (DK group) and postoperative sufentanil analgesia (SUF group). The primary outcomes were the serum levels of interleukin-4 (IL-4), interferon-γ (IFN-γ) and VEGF, and the IFN-γ/IL-4 ratio 30 min before induction (T0), and 24 and 48 h after surgery. Secondary outcomes included numerical rating scale scores at 0 h (T0), 4 h (T1), 12 h (T2), 24 h (T3) and 48 h (T4) postoperatively, cumulative times of rescue analgesia, as well as the incidence of postoperative side effects within 48 h from surgery. Patients in the DK group reported similar analgesic effects as patients in the SUF group at T2, T3 and T4, and the incidence of postoperative nausea and vomiting was significantly lower in the DK group. In the DK group, the serum concentration of IFN-γ and IFN-γ/IL-4 ratio at 24 and 48 h after surgery were higher compared with those in the SUF group. Conversely, the serum concentrations of IL-4 at 24 h after surgery and VEGF at 24 and 48 h after surgery were significantly lower. The results indicated that the combination of DEX and ketorolac for PCA significantly improved postoperative pain and decreased the serum level of VEGF, which are associated with tumor angiogenesis. In addition, it maintained the homeostasis of postoperative immune dysfunction of patients with cervical cancer by shifting the balance between type 1 T helper cells and type 2 T helper cell (Th1/Th2 balance) to Th1 (registration no. ChiCTR1900027979; December 7, 2019).
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Affiliation(s)
- Li Ao
- Department of Anesthesiology, The First Central Clinical School, Tianjin Medical University, Tianjin 300192, P.R. China
- Department of Anesthesiology, Tangshan Maternity and Child Healthcare Hospital, Tangshan, Hebei 063000, P.R. China
| | - Jinlin Shi
- Department of Anesthesiology, Tangshan People's Hospital and Tangshan Cancer Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, P.R. China
| | - Jianhui Gan
- Department of Anesthesiology, Tangshan People's Hospital and Tangshan Cancer Hospital, North China University of Science and Technology, Tangshan, Hebei 063000, P.R. China
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Hongyin Du
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
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Kadantseva K, Subbotin V, Akchulpanov R, Berikashvili L, Yadgarov M, Zhukova L, Kvetenadze G, Svitich O, Kukina P, Kuznetsov I, Shemetova M, Smirnova A, Polyakov P, Shebankov A, Likhvantsev V. The impact of inhalation versus total intravenous anesthesia on the immune status in patients undergoing breast cancer surgery: a double-blind randomized clinical trial (TeMP). Front Oncol 2024; 14:1401910. [PMID: 39132502 PMCID: PMC11310116 DOI: 10.3389/fonc.2024.1401910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Abstract
Background Breast cancer (BC) mortality primarily stems from metastases rather than the primary tumor itself. Perioperative stress, encompassing both surgical and anesthetic factors, profoundly impacts the immune system, leading to alterations in neuroendocrine pathways and immune functions, potentially facilitating tumor progression and metastasis. Understanding the immunomodulatory effects of different anesthesia techniques is crucial for optimizing perioperative care in patients with BC. The neutrophil-to-lymphocyte ratio (NLR) serves as one of the key indicators of perioperative immune response. Objective To compare the effects of inhalation anesthesia (IA) and total intravenous anesthesia (TIVA) on perioperative immune response in BC surgery patients. Methods In this randomized, double-blind clinical trial, BC surgery patients were randomized to receive either TIVA with propofol or IA with sevoflurane. The primary endpoint was NLR assessment. Secondary immune parameters measured included natural killer cells, various T cell subsets, B cells, the immuno-regulatory index [T-helpers (CD3+CD4+)/cytotoxic T-cells (CD3+CD8+)], matrix metallopeptidases (MMP-9), complement components, and immunoglobulins, preoperatively and at 1 and 24 hours postoperatively. Results The study included 98 patients (IA: 48, TIVA: 50). The baseline characteristics exhibited remarkable similarity across the groups. No significant difference in absolute NLR values was found between IA and TIVA groups at any time point (1 hour: p = 0.519, 24 hours: p = 0.333). Decreased IgA and IgM levels post-surgery suggested potential negative impacts of IA on humoral immunity compared to TIVA. CRP levels increased more by 24 hours (p = 0.044) in IA compared to TIVA. No significant differences were observed in natural killer cells, T cell subsets, B cells, MMP-9 levels or complement components between groups. Significant differences in the immuno-regulatory index between the TIVA and IA groups at one hour postoperatively (p = 0.033) were not maintained at 24 hours. Conclusion While there were no notable differences in NLR among the types of anesthesia, the observed disparities in immunoglobulin content and C-reactive protein levels between groups suggest that we cannot dismiss the potential immunosuppressive effects of inhalational anesthesia in breast cancer surgeries. Further investigation needed to clarify the impact of various anesthesia methods on immune function and their implications for long-term cancer outcomes.
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Affiliation(s)
- Kristina Kadantseva
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- Department of Intensive Care and Anesthesiology, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Valery Subbotin
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- Department of Intensive Care and Anesthesiology, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Roman Akchulpanov
- Department of Intensive Care and Anesthesiology, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Levan Berikashvili
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Mikhail Yadgarov
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Lyudmila Zhukova
- Department of Intensive Care and Anesthesiology, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Guram Kvetenadze
- Department of Intensive Care and Anesthesiology, A. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Oxana Svitich
- Department of Immunology, Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Polina Kukina
- Department of Immunology, Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Ivan Kuznetsov
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Mariya Shemetova
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Anastasiya Smirnova
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Petr Polyakov
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Andrey Shebankov
- Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Valery Likhvantsev
- Department of Clinical Trials and intelligent IT, Federal Research and Clinical Centre of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- Department of Intensive Care and Anesthesiology, I. Sechenov First Moscow State Medical University, Moscow, Russia
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Kim J, Yoon S, Song IK, Lee K, Hwang W, Kim H, Lee DK, Lim HK, Kim SH, Lee JW, Hong B, Blank RS, Pedoto A, Popescu W, Theresa G, Martin AK, Patteril M, Pathanasethpong A, Thongsuk Y, Pisitpitayasaree T, Huang A, Yu H, Kapoor PM, Kim K, Chi SA, Ahn HJ. Recurrence-free survival after curative resection of non-small cell lung cancer between inhalational gas anesthesia and propofol-based total intravenous anesthesia: a multicenter, randomized, clinical trial (GAS TIVA trial): protocol description. Perioper Med (Lond) 2024; 13:79. [PMID: 39039548 PMCID: PMC11264408 DOI: 10.1186/s13741-024-00436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/13/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Surgery is the primary treatment for non-small cell lung cancer (NSCLC), but microscopic residual disease may be unavoidable. Preclinical studies have shown that volatile anesthetics might suppress host immunity and promote a pro-malignant environment that supports cancer cell proliferation, migration, and angiogenesis, whereas propofol may preserve cell-mediated immunity and inhibit tumor angiogenesis. However, clinical evidence that propofol-based total intravenous anesthesia (TIVA) can reduce tumor recurrence after curative resection remains inconsistent due to the retrospective observational nature of previous studies. Therefore, we will test the hypothesis that the recurrence-free survival (RFS) after curative resection of NSCLC is higher in patients who received TIVA than volatile anesthetics (GAS) in this multicenter randomized trial. METHODS This double-blind, randomized trial will enroll patients at 22 international sites, subject to study registration, institutional review board approval, and patient written informed consent. Eligible patients are adult patients undergoing lung resection surgery with curative intent for NSCLC. Exclusion criteria will be contraindications to study drugs, American Society of Anesthesiologists physical status IV or higher, or preexisting distant metastasis or malignant tumor in other organs. At each study site, enrolled subjects will be randomly allocated into the TIVA and GAS groups with a 1:1 ratio. This pragmatic trial does not standardize any aspect of patient care. However, potential confounders will be balanced between the study arms. The primary outcome will be RFS. Secondary outcomes will be overall survival and complications within postoperative 7 days. Enrollment of 5384 patients will provide 80% power to detect a 3% treatment effect (hazard ratio of 0.83) at alpha 0.05 for RFS at 3 years. DISCUSSION Confirmation of the study hypothesis would demonstrate that a relatively minor and low-cost alteration in anesthetic management has the potential to reduce cancer recurrence risk in NSCLC, an ultimately fatal complication. Rejection of the hypothesis would end the ongoing debate about the relationship between cancer recurrence and anesthetic management. TRIAL REGISTRATION The study protocol was prospectively registered at the Clinical trials ( https://clinicaltrials.gov , NCT06330038, principal investigator: Hyun Joo Ahn; date of first public release: March 25, 2024) before the recruitment of the first participant.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyuho Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonjung Hwang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Seoul, Republic of Korea
| | - Hyun Kyoung Lim
- Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Republic of Korea
| | - Jong Wha Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Randal S Blank
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Alessia Pedoto
- Department of Anesthesiology and Pain Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Wanda Popescu
- Department of Anesthesiology and Pain Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Glezinis Theresa
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | | | - Mathew Patteril
- Department of Anesthesia and Pain Medicine, University Hospitals of Coventry and Warwickshire, Coventry, UK
- Warwick Medical School, Coventry, UK
| | | | - Yada Thongsuk
- Faculty of Medicine, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Tanatporn Pisitpitayasaree
- Faculty of Medicine, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Aijie Huang
- Department of Anesthesia and Pain Medicine, Yuhuangding Hospital Affiliated to Qingdao University, Shandong, China
| | - Hui Yu
- Department of Anesthesiology, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science, Beijing, China
| | - Poonam Malhotra Kapoor
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kyunga Kim
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Ah Chi
- Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Zhang Y, Yu P, Bian L, Huang W, Li N, Ye F. Survival benefits of propofol-based versus inhalational anesthesia in non-metastatic breast cancer patients: a comprehensive meta-analysis. Sci Rep 2024; 14:16354. [PMID: 39014134 PMCID: PMC11252424 DOI: 10.1038/s41598-024-67291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
Whether the anesthesia technique, inhalational general anesthesia (IGA) or propofol-based anesthesia (PBA), influences the long-term survival of non-metastatic breast cancer (eBC) remain unclear and controversial. We carried out a literature search on 16thJuly, 2022 for studies comparing IGA and PBA in eBC undergoing standard surgery, according to PRISMA 2020. The major endpoint in our study was overall survival (OS). Seventeen studies including four randomized clinical trials and thirteen retrospective cohort studies were included in the meta-analysis. Ten studies provided data for crude OS in unweighted eBC patients (imbalance in baseline characteristics). The summarized estimate HRs of the PBA group versus the IGA group (ten studies, N = 127,774, IGA group: 92,592, PBA group: 35,182.) was 0.83 (95%CI: 0.78-0.89). Compared with IGA, PBA was associated with both better 1-year OS (two studies, N = 104,083, IGA group: 84,074, PBA group: 20,009. Pooled HR = 0.80, 0.73-0.89) and 5-year OS (six studies, N = 121,580, IGA group: 89,472, PBA group: 32,108. HR = 0.80, 0.74-0.87). Ten studies applied PSM method to balance the baseline characteristics. In these weighted patients, PBA still showed a better OS (ten studies, N = 105,459, IGA group: 79,095, PBA group: 26,364. HR = 0.93, 0.87-1.00), a better 1-year OS (two studies, N = 83,007, IGA group: 67,609, PBA group: 15,398. HR = 0.88, 0.78-0.98) and a trend towards a better 5-year OS (nine studies, N = 121,580, IGA group: 76,797, PBA group: 24,066. HR = 0.95, 0.88-1.03). Loco-regional recurrence-free survival (LRRFS) was also better in PBA group (HR = 0.73, 0.61-0.86). The present study is the first comprehensive meta-analysis to demonstrate that propofol-based anesthesia could significantly improve OS and LRRFS in non-metastatic breast cancer patients, compared with inhalational anesthesia.
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Affiliation(s)
- Yingjun Zhang
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cance, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ping Yu
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cance, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Lei Bian
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wanwei Huang
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Na Li
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Feng Ye
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
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Li Y, Sun L, Zhou Q, Lee AJ, Wang L, Zhang R, Wang S. Effects of opioid drugs on immune function in cancer patients. Biomed Pharmacother 2024; 175:116665. [PMID: 38701564 DOI: 10.1016/j.biopha.2024.116665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
Opioid receptor agonists are often used when cancer patients undergo surgery or analgesic treatment. As analgesics in clinical care, opioids can provide intraoperative or to chronic cancer pain relief. Immune function plays an important role in anti-cancer therapy, with cellular immunity, comprised principally of T-lymphocytes and natural killer cells, representing the primary anti-cancer immune response. However, it remains unclear whether immune function is further affected with the use of opioids in already immunocompromised cancer patients. This article provides a review of the effects of commonly used clinical opioids, including morphine, oxycodone, fentanyl and tramadol, on immune function in cancer patients. It provides a summary of current evidence regarding the immunomodulatory effects of opioids in the cancer setting and mechanisms underlying these interactions.
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Affiliation(s)
- Yunqi Li
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Lina Sun
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Qinglian Zhou
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - An Jie Lee
- Biological Sciences, University of California San Diego, La Jolla, CA 92093, United States
| | - Lingyan Wang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China
| | - Rui Zhang
- School of Anesthesiology, Weifang Medical University, Weifang 261053, China.
| | - Shoushi Wang
- Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao 266042, China.
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Ahn HJ. Anesthesia and cancer recurrence: a narrative review. Anesth Pain Med (Seoul) 2024; 19:94-108. [PMID: 38725164 PMCID: PMC11089301 DOI: 10.17085/apm.24041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
Cancer is a leading cause of death worldwide. With the increasingly aging population, the number of emerging cancer cases is expected to increase markedly in the foreseeable future. Surgical resection with adjuvant therapy is the best available option for the potential cure of many solid tumors; thus, approximately 80% of patients with cancer undergo at least one surgical procedure during their disease. Agents used in general anesthesia can modulate cytokine release, transcription factors, and/or oncogenes. This can affect host immunity and the capability of cancer cells to survive and migrate, not only during surgery but for up to several weeks after surgery. However, it remains unknown whether exposure to anesthetic agents affects cancer recurrence or metastasis. This review explores the current literature to explain whether and how the choice of anesthetic and perioperative medication affect cancer surgery outcomes.
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Affiliation(s)
- Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sun D, Li K, Chai Z, Wang L, Gu S, Sun N, Zhang Y, Wang Y, Wang T. Effects of propofol intravenous general anesthesia and inhalational anesthesia on T-lymphocyte activity after breast cancer surgery: A meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 28:86. [PMID: 38510784 PMCID: PMC10953746 DOI: 10.4103/jrms.jrms_336_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/20/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024]
Abstract
Background Breast cancer is one of the most common cancers in women. General anesthesia is a commonly used anesthesia method for breast cancer surgery, and studies have confirmed that general anesthesia can induce immunosuppression in breast cancer patients and increase the metastasis rate of tumors. However, the difference between the effects of intravenous general anesthesia and inhalation anesthesia on the function of T-lymphocytes is still controversial, and it is necessary to explore reasonable anesthesia methods to reduce immunosuppression caused by surgery and anesthesia. Materials and Methods Databases (Embase, PubMed, Cochrane Library, CBM, CNKI, and Wanfang) were searched (up to October 2022) for randomized controlled trials (RCTs) comparing intraoperative inhalation anesthesia and propofol intravenous anesthesia in breast cancer patients, with the outcome of T-lymphocyte subsets. The meta-analysis was performed by STATA 14.0. Results Six RCTs with 352 patients were included in the study. Compared with inhalation anesthesia, there was no difference in T-lymphocyte subsets between the two groups immediately after surgery, but the activities of CD4+ T cells in patients with propofol anesthesia were higher (standard mean difference [SMD] = 0.234, 95% confidence interval [CI]: 0.003-0.466, P = 0.047, I2 = 44.1%) than those under inhalation anesthesia 1 day after surgery, and CD4+/CD8+ activities in patients with propofol anesthesia were higher (SMD = 304, 95% CI: 0.072-0.537, P = 0.010, I2 = 48.0%) than those under inhalation anesthesia 1 day after surgery. Conclusion There were no differences in the effects of propofol and inhalation anesthetics on T-lymphocytes immediately after surgery, but the inhibitory effects of inhalation anesthetics on CD4+ and CD4+/CD8+ cells were stronger 1 day after surgery.
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Affiliation(s)
- Daqi Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunyue Li
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziqi Chai
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijuan Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shimin Gu
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Na Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuxia Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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8
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Yang Y, Zhang Y, Tang Y, Zhang J. Anesthesia-related intervention for long-term survival and cancer recurrence following breast cancer surgery: A systematic review of prospective studies. PLoS One 2023; 18:e0296158. [PMID: 38127958 PMCID: PMC10734918 DOI: 10.1371/journal.pone.0296158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Anesthesia is correlated with the prognosis of cancer surgery. However, evidence from prospective studies focusing on breast cancer is currently limited. This systematic review aimed to investigate the effect of anesthesia-related interventions on oncological outcomes following breast cancer surgery in prospective studies. METHODS Literature searches were performed from inception to June. 2023 in the Pubmed, Web of Science, Embase, and ClinicalTrials databases. The main inclusion criteria comprised a minimum of one-year follow-up duration, with oncological outcomes as endpoints. Anesthesia-related interventions encompassed, but were not limited to, type of anesthesia, anesthetics, and analgesics. The risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS A total of 9 studies were included. Anesthesia-related interventions included paravertebral nerve block (3), pectoral nerve block (1), sevoflurane (2), ketorolac (2), and infiltration of lidocaine (1). Cancer recurrence, metastasis, disease-free survival, or (and) overall survival were assessed. Among all included studies, only infiltration of lidocaine was found to prolong disease-free survival and overall survival. CONCLUSION Regional anesthesia and propofol did not improve oncological outcomes following breast cancer surgery. The anti-tumorigenic effect of ketorolac warrants future studies with larger sample sizes. Perioperative infiltration of lidocaine around the tumor may be a promising anti-tumorigenic intervention that can prolong overall survival in patients with early breast cancer.
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Affiliation(s)
- Yuecheng Yang
- Department of anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yunkui Zhang
- Department of anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yonghong Tang
- Department of anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Zhang
- Department of anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Fan Z, Han D, Fan X, Zhao L. Ovarian cancer treatment and natural killer cell-based immunotherapy. Front Immunol 2023; 14:1308143. [PMID: 38187402 PMCID: PMC10768003 DOI: 10.3389/fimmu.2023.1308143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Ovarian cancer (OC) is one of the malignant tumors that poses a serious threat to women's health. Natural killer (NK) cells are an integral part of the immune system and have the ability to kill tumor cells directly or participate indirectly in the anti-tumor immune response. In recent years, NK cell-based immunotherapy for OC has shown remarkable potential. However, its mechanisms and effects remain unclear when compared to standard treatment. Methods To explore the value of NK cell-based immunotherapy in the treatment of OC, we conducted a literature review. In comparison to standard treatment, our focus was primarily on the current anti-tumor mechanisms, the clinical effect of NK cells against OC, factors affecting the structure and function of NK cells, and strategies to enhance the effectiveness of NK cells. Results We found that NK cells exert their therapeutic effects in OC through mechanisms such as antibody-dependent cell cytotoxicity, perforin release, and granule enzyme secretion. They also secrete IFN-γ and TNF-α or engage in Fas/FasL and TRAIL/TRAILR pathways, mediating the death of OC cells. In clinical trials, the majority of patients experienced disease stability with mild side effects after receiving NK cell-based immunotherapy, but there is still a lack of high-quality research evidence regarding its clinical effectiveness. OC and prior experience with standard treatments have an effect on NK cells, and it may be considered to maximize NK cell effects through the modulation of the tumor microenvironment or combination with other therapies. Conclusions In this review, we have summarized the current evidence of NK cell applications in the treatment of OC. Furthermore, factors and strategies that influence and enhance the role of NK cell immunotherapy are discussed.
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Affiliation(s)
- Zhongru Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Dongyu Han
- Department of Obstetrics and Gynecology, Suzhou Hospital, Affiliated Hospital of Meddical School, Nanjing University, Suzhou, China
| | - Xin Fan
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Zhao
- Department of Obstetrics and Gynecology, Suzhou Hospital, Affiliated Hospital of Meddical School, Nanjing University, Suzhou, China
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10
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Kim HJ, Jeon S, Lee HJ, Bae J, Ri HS, Hong JM, Paek SI, Kwon SK, Kim JR, Park S, Yun EJ. Effects of sevoflurane on metalloproteinase and natural killer group 2, member D (NKG2D) ligand expression and natural killer cell-mediated cytotoxicity in breast cancer: an in vitro study. Korean J Anesthesiol 2023; 76:627-639. [PMID: 37435613 PMCID: PMC10718625 DOI: 10.4097/kja.23323] [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: 04/25/2023] [Revised: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND We investigated the effects of sevoflurane exposure on the expression of matrix metalloproteinase (MMP), expression and ablation of natural killer group 2, member D (NKG2D) ligands (UL16-binding proteins 1-3 and major histocompatibility complex class I chain-related molecules A/B), and natural killer (NK) cell-mediated cytotoxicity in breast cancer cells. METHODS Three human breast cancer cell lines (MCF-7, MDA-MB-453, and HCC-70) were incubated with 0 (control), 600 (S6), or 1200 μM (S12) sevoflurane for 4 h. The gene expression of NKG2D ligands and their protein expression on cancer cell surfaces were measured using multiplex polymerase chain reaction (PCR) and flow cytometry, respectively. Protein expression of MMP-1 and -2 and the concentration of soluble NKG2D ligands were analyzed using western blotting and enzyme-linked immunosorbent assays, respectively. RESULTS Sevoflurane downregulated the mRNA and protein expression of the NKG2D ligand in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells but did not affect the expression of MMP-1 or -2 or the concentration of soluble NKG2D ligands in the MCF-7, MDA-MB-453, and HCC-70 cells. Sevoflurane attenuated NK cell-mediated cancer cell lysis in a dose-dependent manner in MCF-7, MDA-MB-453, and HCC-70 cells (P = 0.040, P = 0.040, and P = 0.040, respectively). CONCLUSIONS Our results demonstrate that sevoflurane exposure attenuates NK cell-mediated cytotoxicity in breast cancer cells in a dose-dependent manner. This could be attributed to a sevoflurane-induced decrease in the transcription of NKG2D ligands rather than sevoflurane-induced changes in MMP expression and their proteolytic activity.
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Affiliation(s)
- Hyae Jin Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soeun Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Institute for Translational Research in Dentistry, Kyungpook National University, Daegu, Korea
| | - Hyeon Jeong Lee
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jaeho Bae
- Department of Biochemistry, Pusan National University School of Medicine, Yangsan, Korea
- PNU BK21 Plus Biomedical Science Education Center, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun-Su Ri
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung In Paek
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seul Ki Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Rin Kim
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seungbin Park
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun-Jung Yun
- Department of Biochemistry, Pusan National University School of Medicine, Yangsan, Korea
- PNU BK21 Plus Biomedical Science Education Center, Pusan National University School of Medicine, Yangsan, Korea
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11
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Wang Y, Sun Y, Hu Y, Xiao Z. Bibliometric Analysis of Anesthetic Drugs' Effects on Immune Function- Current Knowledge, Hotspots and Future Perspectives. Drug Des Devel Ther 2023; 17:3219-3230. [PMID: 37908313 PMCID: PMC10615110 DOI: 10.2147/dddt.s433629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
Objective The objective of this study is to conduct a bibliometric analysis of the present status, areas of focus, and upcoming developments in the research of anesthetic drugs and their impact on immune function, along with other related research domains. Methods From January 1, 2008 to June 9, 2023, A thorough exploration of anesthetic drug-related literature pertaining to immune function was carried out through the utilization of the Web of Science. The bibliometric analysis was predominantly executed by means of CiteSpace, GraphPad Prism 8.0, and the acquisition of data regarding the country, institution, author, journal, and keywords associated with each publication. Results This study analyzed a comprehensive total of 318 publications, consisting of 228 articles and 90 reviews, to determine the publication output of anesthetic drugs on immune function. Notably, China exhibited the highest publication output with (109, 34.28%) articles. Among the institutions analyzed, Harvard University was found to be the most productive with (12, 3.77%) publications. The study findings indicate that Buggy, Donal J (5, 1.57%) and Yuki, Koichi (5, 1.57%) had the highest publication records. Anesthesiology was the most frequently cited journal with a total of (206) citations. The results also revealed that "surgery" was the most frequently used keyword, appearing (48 times), followed by "general anesthesia" (41 times) and "breast cancer" (37 times). The study has identified several current areas of interest, with a particular emphasis on "metastasis", "inflammation", "recurrence", "anesthesia technique", and "induction". It is anticipated that forthcoming research endeavors will concentrate on exploring the impacts of isoflurane, sevoflurane, and ketamine on immune function. Conclusion This study provided a thorough analysis of the research trends and developments in investigating the impact of anesthetic drugs on immune function, incorporating pertinent research and collaborative entities such as authors, institutions, and countries.
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Affiliation(s)
- Yufei Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Ye Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Yunxiang Hu
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Zhaoyang Xiao
- Department of Anesthesiology, The Second Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
- School of Graduates, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
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12
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Abrahams D, Ibrahim-Hashim A, Ackerman RS, Brown JS, Whelan CJ, Garfinkel MB, Gatenby RA, Muncey AR. Immunomodulatory and pro-oncologic effects of ketamine and isoflurane anesthetics in a murine model. PLoS One 2023; 18:e0292492. [PMID: 37816047 PMCID: PMC10564181 DOI: 10.1371/journal.pone.0292492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Volatile and intravenous anesthetics may worsen oncologic outcomes in basic science animal models. These effects may be related to suppressed innate and adaptive immunity, decreased immunosurveillance, and disrupted cellular signaling. We hypothesized that anesthetics would promote lung tumor growth via altered immune function in a murine model and tested this using an immunological control group of immunodeficient mice. METHODS Lewis lung carcinoma cells were injected via tail vein into C57BL/6 immunocompetent and NSG immunodeficient mice during exposure to isoflurane and ketamine versus controls without anesthesia. Mice were imaged on days 0, 3, 10, and 14 post-tumor cell injection. On day 14, mice were euthanized and organs fixed for metastasis quantification and immunohistochemistry staining. We compared growth of tumors measured from bioluminescent imaging and tumor metastasis in ex vivo bioluminescent imaging of lung and liver. RESULTS Metastases were significantly greater for immunocompromised NSG mice than immunocompetent C57BL/6 mice over the 14-day experiment (partial η2 = 0.67, 95% CI = 0.54, 0.76). Among immunocompetent mice, metastases were greatest for mice receiving ketamine, intermediate for those receiving isoflurane, and least for control mice (partial η2 = 0.88, 95% CI = 0.82, 0.91). In immunocompetent mice, significantly decreased T lymphocyte (partial η2 = 0.83, 95% CI = 0.29, 0.93) and monocyte (partial η2 = 0.90, 95% CI = 0.52, 0.96) infiltration was observed in anesthetic-treated mice versus controls. CONCLUSIONS The immune system appears central to the pro-metastatic effects of isoflurane and ketamine in a murine model, with decreased T lymphocytes and monocytes likely playing a role.
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Affiliation(s)
- Dominique Abrahams
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Arig Ibrahim-Hashim
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, United States of America
| | - Robert S. Ackerman
- Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Joel S. Brown
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, United States of America
- Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Christopher J. Whelan
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Megan B. Garfinkel
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Robert A. Gatenby
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
- Department of Cancer Biology and Evolution, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Aaron R. Muncey
- Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
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Huang Q, Zhou R, Hao X, Zhang W, Chen G, Zhu T. Circulating biomarkers in perioperative management of cancer patients. PRECISION CLINICAL MEDICINE 2023; 6:pbad018. [PMID: 37954451 PMCID: PMC10634636 DOI: 10.1093/pcmedi/pbad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/27/2023] [Indexed: 11/14/2023] Open
Abstract
Owing to the advances in surgical technology, most solid tumours can be controlled by surgical excision. The priority should be tumour control, while some routine perioperative management might influence cancer progression in an unnoticed way. Moreover, it is increasingly recognized that effective perioperative management should include techniques to improve postoperative outcomes. These influences are elucidated by the different functions of circulating biomarkers in cancer patients. Here, circulating biomarkers with two types of clinical functions were reviewed: (i) circulating biomarkers for cancer progression monitoring, for instance, those related to cancer cell malignancy, tumour microenvironment formation, and early metastasis, and (ii) circulating biomarkers with relevance to postoperative outcomes, including systemic inflammation, immunosuppression, cognitive dysfunction, and pain management. This review aimed to provide new perspectives for the perioperative management of patients with cancer and highlight the potential clinical translation value of circulating biomarkers in improving outcomes.
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Affiliation(s)
- Qiyuan Huang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ruihao Zhou
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xuechao Hao
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Weiyi Zhang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guo Chen
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Zhu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, China
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14
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Han ZZ, Li M, Zhang Y. The effects of allogeneic and autologous blood transfusion on immune function in patients receiving total hip replacement. Am J Transl Res 2023; 15:4709-4717. [PMID: 37560247 PMCID: PMC10408532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To evaluate the effects of allogeneic and autologous blood transfusion on immune function and postoperative inflammation in patients after total hip replacement. METHODS In this retrospective study, the clinical data of 60 patients undergoing total hip arthroplasty through a posterolateral approach were analyzed. The patients were grouped into an autologous blood transfusion group (allo group) (n = 30) and an autologous blood transfusion group (auto-group) (n = 30) according to the treatment they received. All patients did not receive preoperative and intraoperative blood transfusion. The blood collected in the operation area was transfused to the patients in the auto-group with the autotransfusion device and the allogeneic blood was transfused to the patients in the allo-group after the operation. The average amount of blood transfusion was 400 ml. The immune function after blood transfusion was mainly evaluated by natural killer cell cytotoxicity (NKCC) and interleukin-2 (IL-2) using ELISA kits, meanwhile the changes of cellular immune factor levels (differentiation cluster of differentiation, CD) (CD3+, CD4+) and humoral immune factor levels (Immunoglobulin E, IgE) after blood transfusion were determined by flow cytometry. The secondary outcome was postoperative inflammatory response measured by white blood cell (WBC) count, neutrophil percentage (NP) and C-reactive protein (CRP). RESULTS The parameters of both groups of patients were comparable. The auto-group significantly outperformed the Allo-group in the following laboratory parameters: NKCC (%, E:T = 10:1) at day 2 [26.1 (Auto) vs 19.3 (Allo); P = 0.0025], NKCC (%, E:T = 5:1) at day 2 [20.0 (Auto) vs 17.3 (Allo); P = 0.0094], CD3+ (%) at day 2 [50.5 (Auto) vs 40.8 (Allo); P = 0.0233], CD4+ (%) at day 2 [41.2 (Auto) vs 26.3 (Allo); P = 0.0122], IgE (U/mL) at day 2 [157.8 (Auto) vs 319.8 (Allo); P = 0.0064]. CONCLUSION Autotransfusion can safely replace allogeneic blood transfusion and reduce the damage of postoperative immune function after total hip arthroplasty.
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Affiliation(s)
- Zong-Zheng Han
- Graduate School of Jinzhou Medical UniversityJinzhou 121000, Liaoning, China
- Blood Transfusion Department, Hanchuan People’s HospitalHanchuan 431600, Hubei, China
| | - Miao Li
- Blood Transfusion Department, Hanchuan People’s HospitalHanchuan 431600, Hubei, China
| | - Yong Zhang
- Clinical Laboratory, Huangshi Fifth HospitalHuangshi 420204, Hubei, China
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Enlund M, Berglund A, Enlund A, Lundberg J, Wärnberg F, Wang DX, Ekman A, Ahlstrand R, Flisberg P, Hedlund L, Östlund I, Bergkvist L. Impact of general anaesthesia on breast cancer survival: a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane. EClinicalMedicine 2023; 60:102037. [PMID: 37333664 PMCID: PMC10276257 DOI: 10.1016/j.eclinm.2023.102037] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. Methods From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and per-protocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Findings Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P = 0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR = 1.01 (0.71-1.44); P = 0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P = 0.829, log rank test). Interpretation No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery. Funding Swedish Research Council; Uppsala-Örebro Regional Research Council; Västmanland Regional Research Fund; Västmanland Cancer Foundation; Stig and Ragna Gohrton Foundation; Birgit and Henry Knutsson Foundation.
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Affiliation(s)
- Mats Enlund
- Centre for Clinical Research, Västmanland Hospital Västerås, University of Uppsala, Sweden
| | | | - Anna Enlund
- Centre for Clinical Research, Västmanland Hospital Västerås, University of Uppsala, Sweden
| | - Johan Lundberg
- Department of Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Dong-Xin Wang
- Department of Anaesthesiology, Peking University First Hospital, Beijing, China
| | - Andreas Ekman
- Department of Anaesthesia and Intensive Care, Kalmar Hospital, Kalmar, Sweden
| | - Rebecca Ahlstrand
- Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Per Flisberg
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Lars Hedlund
- Department of Anaesthesia and Intensive Care, Skellefteå Hospital, Sweden
| | - Ingrid Östlund
- Department of Perioperative and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Leif Bergkvist
- Centre for Clinical Research, Västmanland Hospital Västerås, University of Uppsala, Sweden
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Thomas TE, Bowers K, Gomez D, Morgan O, Borowsky PA, Dutta R, Abu Y, Roy S, Rojas KE. The association between perioperative opioids and breast cancer recurrence: a narrative review of the literature. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2023; 4:12. [PMID: 38751469 PMCID: PMC11093068 DOI: 10.21037/tbcr-23-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2024]
Abstract
Background and Objective Opioid use disorder is an evolving crisis, and 17.2% of postsurgical patients continue to fill an opioid prescription one year after surgery. Preclinical studies suggest perioperative opioid use, defined here as opioids used in the setting of operative pain, may be linked to inferior oncologic outcomes. If this were true, opioid minimization strategies for surgical patients may reduce opioid-related deaths in more than one way. This review aims to describe the association between perioperative opioid use and breast cancer recurrence. Methods On November 1, 2021, we searched the Ovid and EMBASE databases for the terms "breast neoplasm", "opioid analgesics", "neoplasm recurrence", and "neoplasm metastasis". Of the 350 articles retrieved, 11 met our inclusion criteria. The review was undertaken using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist for quality. Key Content and Findings Clinical studies report no clear association between perioperative opioid use and local or distant breast cancer recurrence. Mixed results were found when assessing perioperative opioid use and overall survival. Multiple studies paradoxically found opioid use to be associated with lower recurrence rates, despite higher mortality rates. Most studies showed no difference in recurrence or survival in breast cancer surgery patients who did or did not receive opioid-containing analgesia, although most findings were limited by study design and low event rates in patients with breast cancer. Conclusions The lack of a clear connection between perioperative opioid use and breast cancer recurrence contradicts some preclinical data, which describes mechanisms through which opioids upregulate tumor proliferation which might worsen oncologic outcomes. Existing clinical literature is limited to mostly retrospective studies in patients with predominantly early-stage breast cancers, with low event rates. Given the worsening opioid epidemic and preclinical study findings, opioid minimization strategies should still be explored. Future work should be prospective and examine cancer recurrence in high-risk patients with more advanced tumor pathologies.
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Affiliation(s)
- Tanya E. Thomas
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Kara Bowers
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel Gomez
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Orly Morgan
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Rajib Dutta
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yaa Abu
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sabita Roy
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristin E. Rojas
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Cui C, Zhang D, Sun K, Zhu Y, Xu J, Kang Y, Zhang G, Cai Y, Mao S, Long R, Ma J, Dong S, Sun Y. Propofol maintains Th17/Treg cell balance in elderly patients undergoing lung cancer surgery through GABAA receptor. BMC Immunol 2022; 23:58. [PMID: 36434505 PMCID: PMC9701037 DOI: 10.1186/s12865-022-00490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
Propofol is widely used in clinical anesthesia due to its advantages of rapid onset and less adverse reactions. This study focused on the role of propofol in the balance of Th17/Treg in elderly patients with lung cancer during perioperative period. Patients undergoing lung cancer surgery were anesthetized by propofol or sevoflurane. Veinal blood was collected at different time points to evaluate the changes of Th17/Treg cell. Propofol better maintained the balance of Th17/Treg in vivo. The peripheral blood of patients with lung cancer was collected in vitro before surgery. Cluster of differentiation (CD)4+ T cells were obtained and then treated with propofol at different concentrations and γ-aminobutyric acid A (GABAA) receptor antagonists. Propofol affected Th17/Treg cell balance by increasing Th17 cells, decreasing Treg cells, thus elevating Th17/Treg ratio, and inhibited invasion and migration of lung cancer cells through GABAA receptor, which was counteracted by GABAA receptor inhibitors. Subsequently, tumor in situ model of lung cancer in aged mice was established. Propofol anesthetized mice had lower change of Th17/Treg ratio, higher survival rate and less metastasis. In brief, propofol regulated balance of Th17/Treg in elderly patients undergoing lung cancer surgery through GABAA receptor. Additionally, propofol could inhibit metastasis of lung cancer.
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Affiliation(s)
- Can Cui
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Dengwen Zhang
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Ke Sun
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Yi Zhu
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Jindong Xu
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Yin Kang
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Guangyan Zhang
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Yujin Cai
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Songsong Mao
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Ruichun Long
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Jue Ma
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Song Dong
- grid.413405.70000 0004 1808 0686Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
| | - Yi Sun
- grid.413405.70000 0004 1808 0686Department of Anesthesiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 DongChuan Road, Guangzhou, 510080 China
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18
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Gu L, Pan X, Wang C, Wang L. The benefits of propofol on cancer treatment: Decipher its modulation code to immunocytes. Front Pharmacol 2022; 13:919636. [PMID: 36408275 PMCID: PMC9672338 DOI: 10.3389/fphar.2022.919636] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2023] Open
Abstract
Anesthetics are essential for cancer surgery, but accumulated research have proven that some anesthetics promote the occurrence of certain cancers, leading to adverse effects in the lives of patients. Although anesthetic technology is mature, there is no golden drug selection standard for surgical cancer treatment. To afford the responsibility of human health, a more specific regimen for cancer resection is indeed necessary. Immunosuppression in oncologic surgery has an adverse influence on the outcomes of patients. The choice of anesthetic strategies influences perioperative immunity. Among anesthetics, propofol has shown positive effects on immunity. Apart from that, propofol's anticancer effect has been generally reported, which makes it more significant in oncologic surgery. However, the immunoregulative function of propofol is not reorganized well. Herein, we have summarized the impact of propofol on different immunocytes, proposed its potential mechanism for the positive effect on cancer immunity, and offered a conceivable hypothesis on its regulation to postoperative inflammation. We conclude that the priority of propofol is high in oncologic surgery and propofol may be a promising immunomodulatory drug for tumor therapy.
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Affiliation(s)
- Long Gu
- First Operating Room, First Hospital of Jilin University, Changchun, China
| | - Xueqi Pan
- Intensive Care Unit, First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Chongcheng Wang
- Trauma Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lei Wang
- Department of Pediatric Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
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19
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Vrbanović Mijatović V, Gatin L, Tonković D, Bandić Pavlović D, Smuđ Orehovec S, Miklić Bublić M, Mijatović D. THE EFFECT OF REGIONAL VS. GENERAL ANESTHESIA ON THE IMMUNE RESPONSE IN BREAST CANCER SURGERY: A NARRATIVE REVIEW OF THE LITERATURE. Acta Clin Croat 2022; 61:115-120. [PMID: 36824636 PMCID: PMC9942466 DOI: 10.20471/acc.2022.61.s2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
For breast cancer patients, surgery remains the cornerstone in treatment. Perioperative and postoperative period is associated with impaired immune function that can have profound implications for cancer patients in terms of tumor recurrence and metastases. The three main factors include surgery and related neuroendocrine stress response, anesthetic drugs, including opioid analgesics and postoperative pain. The most investigated immune cells are natural killer (NK) cells that are affected by both anesthesia and surgery. It has been demonstrated that ketamine, thiopental, volatile anesthetics, fentanyl and morphine, but not propofol, remifentanil or tramadol reduce the number of circulating NK cells and depress their toxicity. The level of NK cells' cytotoxicity is inversely proportional to the stage and spread of cancer. Regional anesthesia and its potential beneficial effects on the perioperative immune response and long-term outcome after surgery has been investigated as an alternative to general anesthesia in patients undergoing breast cancer surgery. In this paper, we present a review of literature aimed to assess the impact of regional anesthesia techniques on the immune response in patients undergoing breast cancer surgery and how it compares to general anesthesia.
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Affiliation(s)
- Vilena Vrbanović Mijatović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Lucija Gatin
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dinko Tonković
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Daniela Bandić Pavlović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Sanda Smuđ Orehovec
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Surgery
| | - Martina Miklić Bublić
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia
| | - Davor Mijatović
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Surgery
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20
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Abujbarah SM, Jogerst K, Kosiorek HE, Ahmad S, Cronin PA, Casey W, Craner R, Rebecca A, Pockaj BA. Postoperative Hematomas in the Era of Outpatient Mastectomy: Is Ketorolac Really to Blame? Ann Surg Oncol 2022; 29:6395-6403. [PMID: 35849298 DOI: 10.1245/s10434-022-12141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/16/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols following mastectomy with or without implant-based breast reconstruction (IBBR) include ketorolac for multimodal perioperative analgesia. There are concerns that ketorolac could be associated with increased risk of postoperative hematoma formation. METHODS Retrospective review of patients undergoing mastectomy with or without IBBR between January 2013 and December 2019 at a single institution. Patients received 15 mg, 30 mg, or no ketorolac depending on ERAS protocol adherence, patient characteristics, and surgeon preference. Clinically significant hematoma was defined as requiring surgical intervention on day of surgery or postoperative day 1. Patients were compared by demographics, surgical characteristics, ketorolac dose, and hematoma prevalence. Univariable and multivariable logistic regression evaluated hematoma formation odds. RESULTS Eight hundred patients met inclusion criteria: 477 received ketorolac. Those who received ketorolac were younger, had lower ASA scores, were more likely to have bilateral procedures and undergo concomitant IBBR, had longer operative times, were less likely to take antiplatelet or anticoagulation medications, had higher PACU pain scores, and had higher incidence of hematomas requiring surgical intervention. Of the cohort, 4.4% had clinically significant hematomas. The 15 mg and 30 mg ketorolac groups had similar prevalence (6.0% vs 5.8%, p = 0.95). On univariable regression, there were increased odds of hematoma formation in patients who were younger, had bilateral procedures, had longer OR times, and who received ketorolac. On multivariable regression, none of the prior variables remained significant. CONCLUSION After accounting for associations with longer operative times, concomitant IBBR, and bilateral procedures, ketorolac administration did not remain an independent risk factor for hematoma formation.
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Affiliation(s)
- Sami M Abujbarah
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ, USA
| | - Kristen Jogerst
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Research-Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Sarwat Ahmad
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Patricia A Cronin
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William Casey
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ryan Craner
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Alanna Rebecca
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Department of General Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
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21
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Effects of Chinese Herbal Formula on Immune Function and Nutritional Status of Breast Cancer Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5900024. [PMID: 35872927 PMCID: PMC9303106 DOI: 10.1155/2022/5900024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 01/01/2023]
Abstract
Background. Chinese herbal formulas have certain effects on patients with breast cancer (BC). This article discussed the effect of Buqi Yangxue decoction on the immune function and nutritional status of BC patients and provided an evidence for traditional Chinese medicine (TCM) to improve the quality of life and curative effect of BC patients. Methods. 66 cases of BC patients were divided into control group (n =33) and Chinese herbal formula group (n =33). The control group was received with TE chemotherapy, and the Chinese herbal formula group was received with Buqi Yangxue decoction combined with TE chemotherapy. Nutritional status, immune function, TCM symptom quantitative score, and adverse reactions were compared between the two groups. Results. There was no difference in all indexes between the two groups before intervention. After 4 weeks, the nutritional indexes ALB, PA, TRF, and TP in Chinese herbal formula group were higher than those in control group, except HGb. CD3+, CD4+, and CD4+/CD8+ in both groups were sharply higher than before treatment, while CD8+ was dramatically lower, and the changes in Chinese herbal formula group were more obvious than those in control group. In Chinese herbal formula group, the levels of IgG, IgA, and IgM were sharply increased compared with control group. The TCM syndrome scores in both groups were decreased significantly after treatment, especially in Chinese herbal formula group. In addition, nausea and vomiting, inappetence, liver function impairment, leukopenia, and thrombocytopenia occurred in both groups. There was no clear difference in the incidence of adverse reactions between Chinese herbal formula group and control group. Conclusion. Buqi Yangxue decoction can effectively improve the nutritional status and immune function of BC patients, which has important clinical significance for the later comprehensive treatment.
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22
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Kang Z, Zhu G, Su C, Zeng K, Li S, Wu X. Differential effects of remifentanil and sufentanil anesthesia on post-operative pain and cognitive functions. Int Immunopharmacol 2022; 108:108888. [DOI: 10.1016/j.intimp.2022.108888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
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23
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Effect of Different General Anesthesia Methods on the Prognosis of Patients with Breast Cancer after Resection: A Systematic Review and Meta-analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6846079. [PMID: 35799639 PMCID: PMC9256302 DOI: 10.1155/2022/6846079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/15/2022] [Indexed: 12/03/2022]
Abstract
Background The effect of total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) on the prognosis of breast cancer patients has been controversial. The study is aimed at exploring the effects of different anesthesia methods on the postoperative prognosis of breast cancer patients. Methods Literature retrieval was conducted in PubMed, EMBASE, MEDLINE, Embase, CENTRAL, and CNKI databases. The literature topic was to compare the effects of TIVA and IA on the prognosis of patients undergoing breast cancer resection. Two researchers extracted data from the literature independently. This study included randomized controlled trials that evaluated for risk of bias according to the “Risk assessment Tool for Bias in Randomized Trials” in the Cochrane Manual. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in observational studies. The chi-square test was used for the heterogeneity test. Publication bias was assessed using funnel plots and Egger's test. If heterogeneity existed between literature, subgroup analysis and sensitivity analysis were used to explore the source of heterogeneity. Sensitivity analysis was performed by excluding low-quality and different-effect models. Data were statistically analyzed using the Cochrane software RevMan 5.3. Hazard ratio (HR) and 95% confidence interval (CI) were used for statistical description. Results Seven literatures were selected for meta-analysis. There were 9781 patients, 3736 (38.20%) receiving TIVA and 6045 (61.80%) receiving inhalation anesthesia. There was no significant difference in overall survival (OS) between TIVA and IA breast cancer patients (HR = 1.05, 95% CI (0.91, 1.22), Z = 0.70, P = 0.49). There was no difference in the literature (χ2 = 6.82, P = 0.34, I2 = 12%), and there was no obvious publication bias. There was no significant difference in recurrence-free survival (RFS) between TIVA and IA patients (HR = 0.95, 95% CI (0.79, 1.13), Z = 0.61, P = 0.54). There was no heterogeneity in the literature (χ2 = 5.23, P = 0.52, I2 = 0%), and there was no significant publication bias. Conclusion There is no significant difference in OS and RFS between TIVA and IA patients during breast cancer resection. The prognostic effects of TIVA and IA were similar.
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24
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NK and cells with NK-like activities in cancer immunotherapy-clinical perspectives. Med Oncol 2022; 39:131. [PMID: 35716327 DOI: 10.1007/s12032-022-01735-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/13/2022] [Indexed: 01/10/2023]
Abstract
Natural killer (NK) cells are lymphoid cells of innate immunity that take important roles in immune surveillance. NK cells are considered as a bridge between innate and adaptive immunity, and their infiltration into tumor area is related positively with prolonged patient survival. They are defined as CD16+ CD56+ CD3- cells in clinic. NK cells promote cytolytic effects on target cells and induce their apoptosis. Loss of NK cell cytotoxic activity and reduction in the number of activating receptors are the current issues for application of such cells in cellular immunotherapy, which resulted in the diminished long-term effects. The focus of this review is to discuss about the activity of NK cells and cells with NK-like activity including natural killer T (NKT), cytokine-induced killer (CIK) and lymphokine-activated killer (LAK) cells in immunotherapy of human solid cancers.
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25
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Mao Q, Zhang H, Huang J, Liu J, Yang L. The Impact of Application of the Humanistic Nursing Model on Quality of Life and Satisfaction with Nursing among Breast Cancer Patients. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1183-1184. [PMID: 36407745 PMCID: PMC9643242 DOI: 10.18502/ijph.v51i5.9435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 06/16/2023]
Abstract
The article's abstract is not available.
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26
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Xu Z, Tang Z, Yao J, Liang D, Jin F, Liu Y, Guo K, Yang X. Comparison of low-dose morphine intrathecal analgesia and sufentanil PCIA in elderly patients with hip fracture undergoing single spinal anesthesia - a randomized clinical trial. BMC Anesthesiol 2022; 22:124. [PMID: 35477377 PMCID: PMC9044775 DOI: 10.1186/s12871-022-01677-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background The complications of postoperative pain, such as hypertension, hypermetabolism, irritability, and postoperative cognitive dysfunction, significantly affect the postoperative rehabilitation of elderly patients. Intrathecal morphine prolongs analgesia after surgery, but has been implicated in nausea and vomiting, pruritus, postoperative respiratory depression, or apneic episodes. The present study explored the effect and safety of low-dose morphine used adjunctively with bupivacaine during single spinal anesthesia or sufentanil patient-controlled intravenous analgesia (PCIA) in elderly patients with hip fracture surgery. Since elderly patients often need anticoagulant therapy in the early postoperative period, single spinal anesthesia was involved in completing the operation in this study. Methods Eighty elderly patients aged 70–85 years who underwent elective hip fracture surgery with single spinal anesthesia were divided into two groups, 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of morphine (morphine group, group M) and 12.5 mg of 0.5% hyperbaric bupivacaine with 100 µg of sufentanil PCIA (sufentanil group, group S). The analgesia scores using the visual analogue scale (VAS), the Brinell comfort scale (BCS) were evaluated at 6, 12, 24, and 48 h after operation, and adverse reactions were recorded such as nausea and vomiting, pruritus, sedation, respiratory depression, and POD (postoperative delirium) with Delirium Rating Scale-r 98. Results Within 24 h after operation, the analgesic and BCS scores of group M were better than those of group S (P < 0.05). Group M had higher frequency of skin pruritus than group S within 24 h, and the difference was statistically significant. The incidence of POD in group M (2 cases) was lower than that in group S (6 cases) (5.71% vs 18.18%) (P < 0.05) with the DRS-r 98 scores. No significant difference was observed in nausea and vomiting between the two groups, and the difference of severe respiratory depression was not found in both groups. Conclusion Compared with sufentanil PCIA, low-dose intrathecal morphine has a satisfactory analgesic effect, and little effect on the patient's cognitive function with low medical cost. Under effective respiratory monitoring, it can be used safely and effectively in elderly patients with hip fracture. Trial registration Registered with the Chinese Clinical Trial Registry under ChiCTR2100042706. 26/01/2021.
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Affiliation(s)
- Zhifei Xu
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China.
| | - Zairong Tang
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Juan Yao
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Dongliang Liang
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Feng Jin
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Ying Liu
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Kai Guo
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
| | - Xiulu Yang
- Department of Anesthesiology, Gaoyou T.C.M. Hospital, 225600, Jiang Su, P. R. China
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IL-10 Dysregulation Underlies Chemokine Insufficiency, Delayed Macrophage Response, and Impaired Healing in Diabetic Wounds. J Invest Dermatol 2022; 142:692-704.e14. [PMID: 34517005 PMCID: PMC8860852 DOI: 10.1016/j.jid.2021.08.428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023]
Abstract
Persistent inflammation is a major contributor to healing impairment in diabetic chronic wounds. Paradoxically, diabetic wound environment during the acute phase of healing is completely different because it exhibits a reduced macrophage response owing to inadequate expression of CCL2 proinflammatory cytokine. What causes a reduction in CCL2 expression in diabetic wounds early after injury remains unknown. In this study, we report that in contrast to prolonged exposure to high glucose, which makes monocytes proinflammatory, short-term exposure to high glucose causes a rapid monocyte reprogramming, manifested by increased expression and secretion of IL-10, which in an autocrine/paracrine fashion reduces glucose uptake and transforms monocytes into an anti-inflammatory phenotype by dampening signaling through toll-like receptors. We show that IL-10 expression is significantly increased in diabetic wounds during the acute phase of healing, causing significant reductions in toll-like receptor signaling and proinflammatory cytokine production, delaying macrophage and leukocyte responses, and underlying healing impairment in diabetic wounds. Importantly, blocking IL-10 signaling during the acute phase of healing improves toll-like receptor signaling, increases proinflammatory cytokine production, enhances macrophage and leukocyte responses, and stimulates healing in diabetic wounds. We posit that anti-IL-10 strategies have therapeutic potential if added topically after surgical debridement, which resets chronic wounds into acute fresh wounds.
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Wei Q, Xia M, Zhang Q, Wang Z. Effect of intravenous lidocaine infusion on perioperative cellular immunity and the quality of postoperative recovery in breast cancer patients: a randomized controlled trial. Gland Surg 2022; 11:599-610. [PMID: 35402204 PMCID: PMC8984984 DOI: 10.21037/gs-22-134] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/14/2023]
Abstract
BACKGROUND Breast cancer has become the most common malignancy worldwide. Experimental and, retrospective, clinical data indicate that anaesthetic technique might influence the risk of metastasis after cancer surgery by modulating the immune system. The purpose of this study is to investigate the effect of perioperative lidocaine injection on immune cells such as T lymphocytes and natural killer cells (NK cells) and the quality of postoperative recovery in breast cancer patients and to propose new ideas and relevant theoretical evidence for the selection of anesthetic protocols for perioperative tumor patients. METHODS Women (n=68) undergoing primary breast tumour resection were randomly assigned to received 2% lidocaine (n=34; group L) or placebo (normal saline; n=34; group S). Venous blood was collected thirty minutes before surgery (T0), after tumor removal (T1), immediately after surgery (T2), 24 h after surgery (T3), and 48 h after surgery (T4). The percentages of NK cells and T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) in peripheral blood were detected by flow cytometry. Patients' quality of recovery-15 (QoR-15) scores were recorded by questionnaire before and 24 h after the operation, as well as intraoperative propofol and remifentanil dosages, the frequency of 24 h postoperative remedial analgesia, and the incidence of nausea and vomiting, dizziness, and chest tightness. RESULTS There were 62 patients included in the study, and 60 patients were finally analyzed. The difference in the changing trend of NK cell levels in the 2 groups over time was statistically significant (F=7.675, P=0.008). The intraoperative changing trends of CD3+ T cells, CD4+ T cells, and the CD4+/CD8+ ratio over time differed significantly between the 2 groups of patients (P<0.05), whereas the trends of CD8+ T cells did not differ significantly (P>0.05). The QoR-15 score at 24 h after surgery was higher in Group L (128.50±20.25) than in Group S (117.50±19.50), and the difference was statistically significant (P=0.005). No adverse events such as cardiac arrhythmia and lidocaine toxicity occurred in both groups during the perioperative period. CONCLUSIONS Continuous intravenous pumping of lidocaine during the perioperative period has little effect on immune function in breast cancer patients and promotes postoperative recovery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100050445.
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Affiliation(s)
- Qingfeng Wei
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Ming Xia
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Qin Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Zhiping Wang
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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29
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Kim R, Kawai A, Wakisaka M, Kin T. Current Status and Prospects of Anesthesia and Breast Cancer: Does Anesthetic Technique Affect Recurrence and Survival Rates in Breast Cancer Surgery? Front Oncol 2022; 12:795864. [PMID: 35223475 PMCID: PMC8864113 DOI: 10.3389/fonc.2022.795864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 01/13/2023] Open
Abstract
The relationship between the anesthetic technique and cancer recurrence has not yet been clarified in cancer surgery. Surgical stress and inhalation anesthesia suppress cell-mediated immunity (CMI), whereas intravenous (IV) anesthesia with propofol and regional anesthesia (RA) are known to be protective for CMI. Surgical stress, general anesthesia (GA) with inhalation anesthesia and opioids contribute to perioperative immunosuppression and may increase cancer recurrence and decrease survival. Surgical stress and GA activate the hypothalamic-pituitary-adrenal axis and release neuroendocrine mediators such as cortisol, catecholamines, and prostaglandin E2, which may reduce host defense immunity and promote distant metastasis. On the other hand, IV anesthesia with propofol and RA with paravertebral block or epidural anesthesia can weaken surgical stress and GA-induced immunosuppression and protect the host defense immunity. IV anesthesia with propofol and RA or in combination with GA may reduce cancer recurrence and improve patient survival compared to GA alone. We review the current status of the relationship between anesthesia and breast cancer recurrence using retrospective and prospective studies conducted with animal models and clinical samples, and discuss the future prospects for reducing breast cancer recurrence and improving survival rates in breast cancer surgery.
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Affiliation(s)
- Ryungsa Kim
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Ami Kawai
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Megumi Wakisaka
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Takanori Kin
- Department of Breast Surgery, Hiroshima City Hospital, Hiroshima, Japan
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30
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Liu X, Wang Q. Application of Anesthetics in Cancer Patients: Reviewing Current Existing Link With Tumor Recurrence. Front Oncol 2022; 12:759057. [PMID: 35296017 PMCID: PMC8919187 DOI: 10.3389/fonc.2022.759057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Surgery remains the most effective cancer treatment, but residual disease in the form of scattered micro-metastases and tumor cells is usually unavoidable. Whether minimal residual disease results in clinical metastases is a function of host defense and tumor survival and growth. The much interesting intersection of anesthesiology and immunology has drawn increasing clinical interest, particularly, the existing concern of the possibility that the perioperative and intraoperative anesthetic care of the surgical oncology patient could meaningfully influence tumor recurrence. This paper examines current data, including recent large clinical trials to determine whether the current level of evidence warrants a change in practice. Available pieces of evidence from clinical studies are particularly limited, largely retrospective, smaller sample size, and often contradictory, causing several questions and providing few answers. Recent randomized controlled clinical trials, including the largest study (NCT00418457), report no difference in cancer recurrence between regional and general anesthesia after potentially curative surgery. Until further evidence strongly implicates anesthesia in future clinical trials, clinicians may continue to choose the optimum anesthetic-analgesic agents and techniques in consultation with their cancer patients, based on their expertise and current best practice.
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Huang YH, Sue SH, Wu ZS, Huang SM, Lee SY, Wu ZF. Antitumorigenic Effect of Tramadol and Synergistic Effect With Doxorubicin in Human Breast Cancer Cells. Front Oncol 2022; 12:811716. [PMID: 35155248 PMCID: PMC8826738 DOI: 10.3389/fonc.2022.811716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/06/2022] [Indexed: 01/11/2023] Open
Abstract
Background Breast cancer in women is one of the leading causes of cancer mortality worldwide, and curative therapy is the main focus of clinical treatment. Anesthetic-analgesic techniques might alter stress responses and immunity and thereby influence outcomes in cancer patients. This study investigated the effect of tramadol on breast cancer progression and metastasis. Methods The effects of tramadol on two different subtypes of human breast adenocarcinoma cell lines, MDA-MB-231 and MCF-7, were studied with regard to cell growth, migration, colony formation and invasion and normoxic or hypoxic microenvironment for the expression of hypoxia-inducible factor-1α, reactive oxygen species, epithelial-mesenchymal transition related and cyclin-related proteins. The co-administration of tramadol and doxorubicin was studied to determine whether the effective doxorubicin dose might be reduced in combination with tramadol. Results The results showed that tramadol inhibited cell growth at concentrations more than 0.5 and more than 1.0 mg/mL in MDA-MB-231 and MCF-7 cells, respectively. Additionally, cell migration, colony formation and invasion were inhibited in a dose-dependent manner by tramadol in both cell lines. The combination of tramadol and doxorubicin induced synergistic effects in MDA-MD-231 cells and, with specific dosage combinations in MCF-7 cells. Conclusions Tramadol may regulate epithelial-mesenchymal transition and possess cytotoxic effects in breast cancer cells. Tramadol inhibits the progression of breast cancer cells and might be a candidate for combination therapy, especially for triple-negative breast cancer, and is a promising treatment strategy for breast cancer.
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Affiliation(s)
- Yi-Hsuan Huang
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sung-How Sue
- Department of Cardiovascular Surgery, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Zih-Syuan Wu
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Yu Lee
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Effect of major versus minor mastectomy on host immunity in canine mammary cancer. Vet Immunol Immunopathol 2022; 246:110403. [DOI: 10.1016/j.vetimm.2022.110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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Fang P, Zhou J, Xia Z, Lu Y, Liu X. Effects of Propofol Versus Sevoflurane on Postoperative Breast Cancer Prognosis: A Narrative Review. Front Oncol 2022; 11:793093. [PMID: 35127500 PMCID: PMC8811129 DOI: 10.3389/fonc.2021.793093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022] Open
Abstract
Perioperative interventions produce substantial biologic perturbations which are associated with the risk of recurrence after cancer surgery. The changes of tumor microenvironment caused by anesthetic drugs received increasing attention. Till now, it’s still unclear whether or not anesthetic drugs may exert positive or negative impact on cancer outcomes after surgery. Breast cancer is the most common tumor and the leading cause of cancer deaths in women. Propofol and sevoflurane are respectively the most commonly used intravenous and inhaled anesthetics. Debates regarding which of the two most commonly used anesthetics may relatively contribute to the recurrence and metastasis vulnerability of breast cancer postoperatively remain. This review aimed to provide a comprehensive view about the effect of propofol versus sevoflurane on the prognosis of breast cancer obtained from pre-clinical studies and clinical studies. Laboratory and animal studies have demonstrated that sevoflurane may enhance the recurrence and metastasis of breast cancer, while propofol is more likely to reduce the activity of breast cancer cells by attenuating the suppression of the immune system, promoting tumor cells apoptosis, and through other direct anti-tumor effects. However, retrospective clinical studies have shown contradictory results about the effects of propofol and sevoflurane on long-term survival in breast cancer patients. Furthermore, recent prospective studies did not identify significant differences between propofol and sevoflurane in breast cancer metastasis and recurrence. Therefore, more preclinical studies and randomized controlled studies are needed to guide the choice of anesthetics for breast cancer patients.
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Affiliation(s)
- Panpan Fang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiaqi Zhou
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhengyuan Xia
- Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Yao Lu, ; Zhengyuan Xia,
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Yao Lu, ; Zhengyuan Xia,
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Jing Y, Zhang Y, Pan R, Ding K, Chen R, Meng Q. Effect of Inhalation Anesthetics on Tumor Metastasis. Technol Cancer Res Treat 2022; 21:15330338221121092. [PMID: 36131554 PMCID: PMC9502254 DOI: 10.1177/15330338221121092] [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] [Indexed: 11/17/2022] Open
Abstract
Many factors affect the prognosis of patients undergoing tumor surgery, and anesthesia is one of the potential influencing factors. In general anesthesia, inhalation anesthesia is widely used in the clinic because of its strong curative effect and high controllability. However, the effect of inhalation anesthetics on the tumor is still controversial. More and more research has proved that inhalation anesthetics can intervene in local recurrence and distant metastasis of tumor by acting on tumor biological behavior, immune response, and gene regulation. In this paper, we reviewed the research progress of diverse inhalation anesthetics promoting or inhibiting cancer in the critical events of tumor recurrence and metastasis, and compared the effects of inhalation anesthetics on patients' prognosis in clinical studies, to provide theoretical reference for anesthesia management of patients undergoing tumor surgery.
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Affiliation(s)
- Yixin Jing
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiguo Zhang
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China
| | - Rui Pan
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Ding
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Chen
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, 117921Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingtao Meng
- Department of Anesthesiology, 117921Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, 117921Renmin Hospital of Wuhan University, Wuhan, China
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Lim J, Chen D, McNicol E, Sharma L, Varaday G, Sharma A, Wilson E, Wright-Yatsko T, Yaeger L, Gilron I, Finnerup NB, Haroutounian S. Risk factors for persistent pain after breast and thoracic surgeries: a systematic literature review and meta-analysis. Pain 2022; 163:3-20. [PMID: 34001769 DOI: 10.1097/j.pain.0000000000002301] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Persistent postsurgical pain (PPSP) is common after breast and thoracic surgeries. Understanding which risk factors consistently contribute to PPSP will allow clinicians to apply preventive strategies, as they emerge, to high-risk patients. The objective of this work was to systematically review and meta-analyze the literature on risk factors of PPSP after breast and thoracic surgeries. A systematic literature search using Ovid Medline, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus databases was conducted. Study screening with inclusion and exclusion criteria, data extraction, and risk of bias assessment was performed independently by 2 authors. The data for each surgical group were analyzed separately and meta-analyzed where possible. The literature search yielded 5584 articles, and data from 126 breast surgery and 143 thoracic surgery articles were considered for meta-analysis. In breast surgery, younger age, higher body mass index, anxiety, depression, diabetes, smoking, preoperative pain, moderate to severe acute postoperative pain, reoperation, radiotherapy, and axillary lymph node dissection were the main factors associated with higher risk of PPSP. In thoracic surgery, younger age, female sex, hypertension, preoperative pain, moderate to severe acute postoperative pain, surgical approach, major procedure, and wound complications were associated with PPSP. This systematic review demonstrated certain consistent risk factors of PPSP after breast and thoracic surgeries, as well as identified research gaps. Understanding the factors that increase susceptibility to PPSP can help selectively allocate resources to optimize perioperative care in high-risk patients and help develop targeted, risk-stratified interventions for PPSP prevention.
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Affiliation(s)
- Joshua Lim
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Dili Chen
- University of Sydney School of Medicine, Sydney, Australia
| | | | - Lokesh Sharma
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Grihith Varaday
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anshuman Sharma
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Elizabeth Wilson
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Tiffany Wright-Yatsko
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Lauren Yaeger
- Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston, Ontario, Canada
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Effect of anaesthesia for mastectomy on cell-mediated immunity in dogs with mammary cancer. Vet Anaesth Analg 2022; 49:265-274. [DOI: 10.1016/j.vaa.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/29/2021] [Accepted: 09/08/2021] [Indexed: 01/22/2023]
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Shaji S, Smith C, Forget P. Perioperative NSAIDs and Long-Term Outcomes After cancer Surgery: a Systematic Review and Meta-analysis. Curr Oncol Rep 2021; 23:146. [PMID: 34748112 PMCID: PMC8575753 DOI: 10.1007/s11912-021-01133-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW This review investigated the use of perioperative non-steroidal anti-inflammatory drugs (NSAIDs) and long-term outcomes in cancer surgery patients, and whether this is dependent on cancer type, type of NSAID and timing of administration. FINDINGS Perioperative NSAID use was found to be associated with longer disease-free survival (hazard ration, HR = 0.84 (95% CI, 0.73-0.97)) and overall survival (HR = 0.78 (95% CI, 0.64-0.94)). No difference was found between different types of NSAID for disease-free survival, although in overall survival ketorolac use was significant (HR = 0.63 (95% CI, 0.42-0.95)). Analysis on the timing of NSAID administration found no subgroup to be associated with cancer outcomes. The cancer-type analysis found an association with outcomes in breast and ovarian cancers. However, the level of certainty remains very low, mostly due to the heterogeneity and the retrospective nature of most studies. Perioperative NSAID use may be associated with increased disease-free and overall survival after cancer surgery. This may be dependent on the type of cancer and type of NSAID, and further research is needed to support this. These data may inform future prospective trials, which are needed to determine the clinical impact, as well as optimal NSAID regimen.
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Affiliation(s)
- Shebin Shaji
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Health Campus, Aberdeen, AB25 2ZD, UK.
| | - Charlotte Smith
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Health Campus, Aberdeen, AB25 2ZD, UK.
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Health Campus, Aberdeen, AB25 2ZD, UK
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK
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Market M, Tennakoon G, Auer RC. Postoperative Natural Killer Cell Dysfunction: The Prime Suspect in the Case of Metastasis Following Curative Cancer Surgery. Int J Mol Sci 2021; 22:ijms222111378. [PMID: 34768810 PMCID: PMC8583911 DOI: 10.3390/ijms222111378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Surgical resection is the foundation for the curative treatment of solid tumors. However, metastatic recurrence due to the difficulty in eradicating micrometastases remain a feared outcome. Paradoxically, despite the beneficial effects of surgical removal of the primary tumor, the physiological stress resulting from surgical trauma serves to promote cancer recurrence and metastasis. The postoperative environment suppresses critical anti-tumor immune effector cells, including Natural Killer (NK) cells. The literature suggests that NK cells are critical mediators in the formation of metastases immediately following surgery. The following review will highlight the mechanisms that promote the formation of micrometastases by directly or indirectly inducing NK cell suppression following surgery. These include tissue hypoxia, neuroendocrine activation, hypercoagulation, the pro-inflammatory phase, and the anti-inflammatory phase. Perioperative therapeutic strategies designed to prevent or reverse NK cell dysfunction will also be examined for their potential to improve cancer outcomes by preventing surgery-induced metastases.
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Affiliation(s)
- Marisa Market
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 8M5, Canada; (M.M.); (G.T.)
- The Ottawa Hospital Research Institute, Ottawa, ON K1G 4E3, Canada
| | - Gayashan Tennakoon
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 8M5, Canada; (M.M.); (G.T.)
| | - Rebecca C. Auer
- The Ottawa Hospital Research Institute, Ottawa, ON K1G 4E3, Canada
- Department of General Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
- Correspondence: ; Tel.: +1-613-722-7000
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Aboalsoud RAHED, Arida EAM, Sabry LAA, Elmolla AF, Mohammad Ghoneim HED. The effect of opioid free versus opioid based anaesthesia on breast cancer pain score and immune response. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1983366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | | | | | - Ahmed Fawzy Elmolla
- Anaesthesia and Pain Management Medical Research Institute, University of Alexandria
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Raigon Ponferrada A, Guerrero Orriach JL, Molina Ruiz JC, Romero Molina S, Gómez Luque A, Cruz Mañas J. Breast Cancer and Anaesthesia: Genetic Influence. Int J Mol Sci 2021; 22:7653. [PMID: 34299272 PMCID: PMC8307639 DOI: 10.3390/ijms22147653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022] Open
Abstract
Breast cancer is the leading cause of mortality in women. It is a heterogeneous disease with a high degree of inter-subject variability even in patients with the same type of tumor, with individualized medicine having acquired significant relevance in this field. The clinical and morphological heterogeneity of the different types of breast tumors has led to a diversity of staging and classification systems. Thus, these tumors show wide variability in genetic expression and prognostic biomarkers. Surgical treatment is essential in the management of these patients. However, the perioperative period has been found to significantly influence survival and cancer recurrence. There is growing interest in the pro-tumoral effect of different anaesthetic and analgesic agents used intraoperatively and their relationship with metastatic progression. There is cumulative evidence of the influence of anaesthetic techniques on the physiopathological mechanisms of survival and growth of the residual neoplastic cells released during surgery. Prospective randomized clinical trials are needed to obtain quality evidence on the relationship between cancer and anaesthesia. This document summarizes the evidence currently available about the effects of the anaesthetic agents and techniques used in primary cancer surgery and long-term oncologic outcomes, and the biomolecular mechanisms involved in their interaction.
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Affiliation(s)
- Aida Raigon Ponferrada
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Malaga, Spain; (A.R.P.); (A.G.L.)
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
| | - Jose Luis Guerrero Orriach
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Malaga, Spain; (A.R.P.); (A.G.L.)
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, 29010 Malaga, Spain
| | - Juan Carlos Molina Ruiz
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
| | - Salvador Romero Molina
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
| | - Aurelio Gómez Luque
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Malaga, Spain; (A.R.P.); (A.G.L.)
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, 29010 Malaga, Spain
| | - Jose Cruz Mañas
- Department of Anaesthesiology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (J.C.M.R.); (S.R.M.); (J.C.M.)
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Pang QY, Duan LP, Jiang Y, Liu HL. Comparison of Outcomes After Breast Cancer Surgery Between Inhalational and Propofol-Based Intravenous Anaesthesia: A Systematic Review and Meta-Analysis. J Pain Res 2021; 14:2165-2177. [PMID: 34295185 PMCID: PMC8291825 DOI: 10.2147/jpr.s315360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/06/2021] [Indexed: 01/07/2023] Open
Abstract
Background General anaesthesia is the commonly provided for breast cancer surgery, but the effects of inhalational anaesthesia and propofol-based intravenous anaesthesia on short- and long-term outcomes after breast cancer surgery are not clear. In this study, we conduct a meta-analysis of randomized controlled trials (RCTs) to explore the superior anaesthetic for breast cancer surgery patients. Methods We searched the Embase, Medline, Cochrane Library, Web of Science, CNKI, and Wanfang databases (up to January, 2021) for RCTs in which inhalational anaesthesia and propofol-based intravenous anaesthesia were compared and short- and long-term outcomes were assessed in breast cancer surgical patients. The meta-analysis was performed by Stata 12.0. Results Twenty RCTs with a total of 2201 patients were included. Compared with inhalational anaesthesia, propofol-based intravenous anaesthesia was associated with more postoperative rescue analgesia (I2=0%, RR: 1.18, 95% CI: 1.07–1.30, P=0.001) but a lower incidence of postoperative nausea and vomiting (PONV) (I2=25.5%, RR: 0.71, 95% CI: 0.62–0.81, P<0.001) and postoperative rescue antiemetics (I2=0%, RR: 0.69, 95% CI: 0.58–0.82, P<0.001). Propofol-based intravenous anaesthesia preserved nature killer cell cytotoxicity (I2=86.2%, SMD: 0.76, 95% CI: 0.13–1.39, P=0.018), decreased IL-6 level (I2=98.0%, SMD: −3.09, 95% CI: −5.70– −0.48, P=0.021) and neutrophil-to-lymphocyte ratio (I2=0%, SMD: −0.28, 95% CI: −0.53– −0.03, P=0.030), and increased 2-year recurrence-free survival rate (I2=0%, RR: 1.10, 95% CI: 1.00–1.20, P=0.043) but did not affect recurrence or the overall survival rate (P>0.05). Conclusion Propofol-based intravenous anaesthesia increases postoperative rescue analgesia but reduces PONV compared with inhalational anaesthesia in breast cancer surgery. The benefit of propofol over inhalational anaesthetics in the preservation of anti-cancer immunity is obvious, but it is difficult to conclude that propofol can exert long-term benefits due to the small sample size.
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Affiliation(s)
- Qian-Yun Pang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Li-Ping Duan
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Yan Jiang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China
| | - Hong-Liang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing University, Chongqing, 400030, People's Republic of China
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Long-term survival differences between sevoflurane and propofol use in general anesthesia for gynecologic cancer surgery. J Anesth 2021; 35:495-504. [PMID: 34008073 DOI: 10.1007/s00540-021-02941-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to evaluate the influence of anesthetic management with propofol or sevoflurane on the prognosis of patients undergoing gynecologic cancer surgery. METHODS This retrospective cohort study included patients who underwent gynecologic cancer (cervical, endometrial, and ovarian cancer) surgery between 2006 and 2018 at the National Hospital Organization Osaka National Hospital. Patients were grouped according to anesthesia type for maintenance of anesthesia: propofol or sevoflurane. After propensity score matching, Kaplan-Meier survival curves were constructed for overall survival, cancer-specific survival, and recurrence-free survival. Univariate and multivariate cox regression models were used to compare hazard ratios for recurrence-free survival. RESULTS A total of 193 patients with propofol and 94 with sevoflurane anesthesia were eligible for analysis. After propensity score matching, 94 patients remained in each group. The sevoflurane group showed significantly lower survival rates than the propofol group with respect to 10-year overall survival (89.3% vs. 71.6%; p = 0.007), 10-year cancer-specific survival (91.0% vs 80.2%; p = 0.039), and 10-year recurrence-free survival (85.6% vs. 67.7%; p = 0.008). Sevoflurane anesthesia was identified as an independent risk factor for recurrence-free survival. Furthermore, distant recurrence was significantly more frequent in the sevoflurane group than in the propofol group (p < 0.001). CONCLUSION In patients undergoing gynecologic cancer surgery, sevoflurane anesthesia was associated with worse overall, cancer-specific, and recurrence-free survival than propofol anesthesia.
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Early postoperative pain after laparoscopic donor nephrectomy predicts 30-day postoperative infectious complications: a pooled analysis of randomized controlled trials. Pain 2021; 161:1565-1570. [PMID: 32107359 DOI: 10.1097/j.pain.0000000000001842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our research group recently published a positive association between early postoperative pain and 30-day postoperative complications in a broad surgical population. To investigate whether heterogeneity of the population and surgical procedures influenced these results, we explored this association in a homogenous surgical population. A secondary analysis of the LEOPARD-2 (clinicaltrials.gov NCT02146417) and RELAX-1 study (NCT02838134) in laparoscopic donor nephrectomy patients (n = 160) was performed. Pain scores on the postanesthesia care unit and postoperative day (POD) 1 and 2 were compared between patients with infectious, noninfectious, and no complications 30 days after surgery. Patients who developed infectious complications had significantly higher pain scores on POD1 and 2 (6.7 ± 2.1 and 6.4 ± 2.8) than patients without complications (4.9 ± 2.2 and 4.1 ± 1.9), respectively (P = 0.006 and P = 0.000). Unacceptable pain (numeric rating scale [NRS] ≥ 6) on POD1 was reported by 72% of patients who developed infectious complications, compared to 38% with noninfectious complications and 30% without complications (P = 0.018). This difference was still present on POD2 at 67% with infectious complications, 21% with noninfectious, and 40% without complications (P = 0.000). Multiple regression analysis identified unacceptable pain (numeric rating scale ≥6) on POD2 as a significant predictor for 30-day infectious complications (odds ratio 6.09, P = 0.001). Results confirm the association between early postoperative pain and 30-day infectious complications in a separate, homogenous surgical population. Further clinical trials should focus on finetuning of postoperative analgesia to elucidate the effects on the endocrine and immune response, preserve immune homeostasis, and prevent postoperative infectious complications.
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Plücker J, Wirsik NM, Ritter AS, Schmidt T, Weigand MA. Anaesthesia as an influence in tumour progression. Langenbecks Arch Surg 2021; 406:1283-1294. [PMID: 33523307 PMCID: PMC8370957 DOI: 10.1007/s00423-021-02078-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022]
Abstract
Purpose Tumour growth and the formation of metastases are essential elements in the progression of cancer. The centre of treatment is the surgical resection of primary solid tumours. But even if the tumour can be removed without microscopic residual cells, local recurrences and distant metastases occur and determine the patient’s fate. During the operation, tumour cells are shed from the primary tumour and released into the circulation. These circulating tumour cells might play an important role in the formation of new tumour sites. Therefore, a functional innate and adaptive immune system is essential, especially in this perioperative period. Anaesthesia influences consciousness and pain perception and interacts directly with the immune system and tumour cells. Methods Review of the current literature concerning intra- and postoperative anaesthetic decisions and tumour progression. Results There are beneficial aspects for patient survival associated with total intravenous anaesthesia, the use of regional anaesthetics and the avoidance of allogeneic red blood cell transfusions. Alternatives such as irradiated intraoperative blood salvage and preoperative iron supplementation may be advantageous in cases where transfusions are limited or not wanted. The immunosuppressive properties of opioids are theoretical, but strong evidence to avoid them does not exist. The application of nonsteroidal anti-inflammatory drugs and postoperative nausea and vomiting prophylaxis do not impair the patient’s survival and may even have a positive effect on tumour regression. Conclusion Anaesthesia does play an important part in the perioperative period in order to improve the cancer-related outcome. Further research is necessary to make more concrete recommendations.
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Affiliation(s)
- Jadie Plücker
- Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany.
| | - Naita M Wirsik
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany
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Effects of transcutaneous electrical acupoint stimulation on perioperative immune function and postoperative analgesia in patients undergoing radical mastectomy: A randomized controlled trial. Exp Ther Med 2021; 21:184. [PMID: 33488793 PMCID: PMC7812592 DOI: 10.3892/etm.2021.9615] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
Radical mastectomy may lead to suppression of cellular immune function in patients with malignant tumors. Transcutaneous electrical acupoint stimulation (TEAS) is widely used in clinical practice. However, there have been relatively few studies on the effects of TEAS on postoperative analgesia and immune function. The present study aimed to evaluate the effects of TAES on postoperative pain and immune function in patients undergoing radical mastectomy. A total of 65 patients were enrolled and allocated to either receive TEAS or sham TEAS. TEAS was implemented on bilateral Hegu (LI4), Neiguan (PC6) and Zusanli (ST36) acupoints simultaneously for 30 min before induction of anesthesia at 4 and 12 h post-operation. The primary outcomes included visual analogue scale (VAS) scores at 4 h (T1), 12 h T2), 24 h (T3) and 48 h (T4) post-operation, and serum levels of IL-2, IL-4, IFN-γ and the IL-2/IL-4 ratio at 30 min before TEAS (T0), T1, T2, T3 and T4. Secondary outcomes included the cumulative time of rescue analgesia within 48 h post-surgery, as well as the incidence of postoperative nausea and vomiting (PONV) and pruritus. Compared with the sham TEAS group, postoperative VAS scores at T2 and T3, the total consumption of opioids in the patient-controlled analgesia (PCA) pump, pressing times of the PCA pump and the incidences of PONV and headache were significantly lower in the TEAS group. The serum levels of IFN-γ at T3 and T4, and the serum levels of IL-2 and the IL-2/IL-4 ratio at T2, T3 and T4 were higher in the TEAS group compared with the sham TEAS group. By contrast, the serum levels of IL-4 were lower at T2, T3 and T4 in the TEAS group compared with the sham TEAS group. The results indicated that TEAS could improve postoperative analgesia, reduce postoperative consumption of opioids and alleviate postoperative side effects. Simultaneously, TEAS was able to reverse decreased serum levels of IL-2 and IFN-γ, reduce the level of IL-4 and restore the balance of Th1/Th2, thereby partially attenuating perioperative immune function depression in patients with breast cancer. The current trial was registered prior to participant enrollment at www.chictr.org.cn (Clinical Trial no. ChiCTR1800017768).
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Schmoch T, Jungk C, Bruckner T, Haag S, Zweckberger K, von Deimling A, Brenner T, Unterberg A, Weigand MA, Uhle F, Herold-Mende C. The anesthetist's choice of inhalational vs. intravenous anesthetics has no impact on survival of glioblastoma patients. Neurosurg Rev 2020; 44:2707-2715. [PMID: 33354749 PMCID: PMC8490243 DOI: 10.1007/s10143-020-01452-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Recent data suggest that the type of anesthesia used during the resection of solid tumors impacts the long-term survival of patients favoring total-intravenous-anesthesia (TIVA) over inhalative-anesthesia (INHA). Here we sought to query this impact on survival in patients undergoing resection of glioblastoma (GBM). All patients receiving elective resection of a newly diagnosed, isocitrate-dehydrogenase-1-(IDH1)-wildtype GBM under general anesthesia between January 2010 and June 2017 in the Department of Neurosurgery, Heidelberg University Hospital, were included. Patients were grouped according to the applied anesthetic technique. To adjust for potential prognostic confounders, patients were matched in a 1:2 ratio (TIVA vs. INHA), taking into account the known prognostic factors: age, extent of resection, O-6-methylguanine-DNA-methyltransferase-(MGMT)-promoter-methylation-status, pre-operative Karnofsky-performance-index and adjuvant radio- and chemotherapy. The primary endpoint was progression-free-survival (PFS) and the secondary endpoint was overall-survival (OS). In the study period, 576 patients underwent resection of a newly diagnosed, IDH-wildtype GBM. Patients with incomplete follow-up-data, on palliative treatment, having emergency or awake surgery; 54 patients remained in the TIVA-group and 417 in the INHA-group. After matching, 52 patients remained in the TIVA-group and 92 in the INHA-group. Median PFS was 6 months in both groups. The median OS was 13.5 months in the TIVA-group and 13.0 months in the INHA-group. No significant survival differences associated with the type of anesthesia were found either before or after adjustment for known prognostic factors. This retrospective study supports the notion that the current anesthetic approaches employed during the resection of IDH-wildtype GBM do not impact patient survival.
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Affiliation(s)
- Thomas Schmoch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christine Jungk
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Sabine Haag
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Zweckberger
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and Clinical Cooperation Unit (CCU) Neuropathology, DKFZ, Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Andreas Unterberg
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Neurosurgical Research, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
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Elsabeeny WY, Shehab NN, Wadod MA, Elkady MA. Perioperative Analgesic Modalities for Breast Cancer Surgeries: A Prospective Randomized Controlled Trial. J Pain Res 2020; 13:2885-2894. [PMID: 33209056 PMCID: PMC7669532 DOI: 10.2147/jpr.s274808] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Various analgesic modalities are adopted for perioperative analgesia in breast cancer surgeries. This study aimed to compare the efficacy of intravenous morphine versus serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in breast cancer surgeries. Patients and Methods Seventy-five breast cancer patients undergoing modified radical mastectomy from January 2020 to June 2020 were randomly allocated into 3 groups; the morphine group received morphine 0.1 mg/kg, the SAPB group received ultrasound-guided SAPB with 25 mL bupivacaine 0.25% and the ESPB group received ultrasound-guided ESPB with 25 mL bupivacaine 0.25%. A visual analogue scale (VAS) 0–10 was used to evaluate pain postoperatively, where 0 denotes no pain and 10 worst pain. If any patient in the 3 studied groups reported breakthrough pain with VAS ≥ 4 then a bolus of 3 mg morphine was given. Results There was no difference in VAS scores between the 3 groups postoperatively. Morphine consumption was higher in the morphine group (9.19 ± 2.32 mg) than the SAPB group (4.00 ± 1.55 mg) and the ESPB group (4.20 ± 1.64 mg), respectively. First time to receive postoperative morphine was significantly longer for the ESPB and SAPB groups than the morphine group (20.40 ± 4.98 hours), (19.00 ± 5.9 hours), (5.00 ± 4.62 hours), respectively. Intraoperative hemodynamics and fentanyl consumption showed no difference between groups, whereas postoperative mean arterial blood pressure values at 2 and 4 hours were higher in the morphine group. Ramsay sedation score and postoperative nausea and vomiting values in the post anesthesia care unit were higher for the morphine group compared to the SAPB and ESPB groups. No complications related to the blocks were reported. Conclusion SAPB and ESPB can be used as an effective and safe alternative to opioids with fewer side effects in breast cancer patients undergoing modified radical mastectomy. Trial Registration This trial was prospectively registered at Clinical Trials.gov on 22 January 2020 with registration number NCT04248608 (https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009JS5&selectaction=Edit&uid=U0004LIG&ts=7&cx=−81xkwa).
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Affiliation(s)
- Walaa Y Elsabeeny
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nahla N Shehab
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Wadod
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa A Elkady
- Department of Anesthesia and Pain Management, National Cancer Institute, Cairo University, Cairo, Egypt
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Jeon S, Kim HK, Kwon JY, Baek SH, Ri HS, Choi HJ, Cho HR, Lee YS, Kim JY, Kim J, Bae J, Lee HJ. Role of Sevoflurane on Natural Killer Group 2, Member D-Mediated Immune Response in Non-Small-Cell Lung Cancer: An In Vitro Study. Med Sci Monit 2020; 26:e926395. [PMID: 33139690 PMCID: PMC7648410 DOI: 10.12659/msm.926395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to investigate the effects of sevoflurane on cancer immunosurveillance and metastasis in non-small-cell lung cancer (NSCLC). Material/Methods NCI-H23 cells, a human NSCLC cell line, were incubated with or without sevoflurane at the concentrations of 0, 12.5, 25, 50, 100, and 200 μM for 6 h. Cell viability, the expression of natural killer group 2, member D ligands (NKG2D ligands: UL16-binding proteins 1–3 [ULBP1–3] and major histocompatibility complex class I chain-related molecules A/B [MICA/B]), the expression of matrix metalloproteinases (MMPs), NK cell-mediated cytotoxicity, and cancer cell migration were measured. Results At 12.5, 25, 50, and 100 μM, sevoflurane increased the expression of NKG2D ligands (ULBP2–3 and MICA, ULBP1–3, ULBP1–3, and ULBP1, respectively). Sevoflurane decreased the expression of NKG2D ligands at 200 μM (MICA/B). NK cell-mediated lysis of NCI-H23 cells at 200 μM sevoflurane was significantly reduced compared with the control (P=0.025; target cell: effect cell=1: 10). Sevoflurane increased the expression of MMP-1, -2, and -9 and increased cell migration in NCI-H23 cells at 50, 100, and 200 μM (P=0.001, 0.035, and 0.039, respectively, compared with the control after 18 h of wound formation). Conclusions Sevoflurane could suppress NKG2D-mediated NK cell cytotoxicity and increased expression of MMPs and migration in NCI-H23 cells. Further research is needed to determine the effects of sevoflurane on cancer immunosurveillance and metastasis in NSCLC.
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Affiliation(s)
- Soeun Jeon
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, South Korea
| | - Hae-Kyu Kim
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea
| | - Jae-Young Kwon
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea
| | - Seung-Hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea
| | - Hyun-Su Ri
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, South Korea
| | - Ho Jung Choi
- Department of Biochemistry, Pusan National University, School of Medicine, Yangsan, South Korea.,PNU BK21 Plus Biomedical Science Education Center, Pusan National University, School of Medicine, Yangsan, South Korea
| | - Hae-Ryung Cho
- Department of Biochemistry, Pusan National University, School of Medicine, Yangsan, South Korea.,PNU BK21 Plus Biomedical Science Education Center, Pusan National University, School of Medicine, Yangsan, South Korea
| | - Young Shin Lee
- Department of Biochemistry, Pusan National University, School of Medicine, Yangsan, South Korea.,PNU BK21 Plus Biomedical Science Education Center, Pusan National University, School of Medicine, Yangsan, South Korea
| | - Joo-Young Kim
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jinsil Kim
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea
| | - Jaeho Bae
- Department of Biochemistry, Pusan National University, School of Medicine, Yangsan, South Korea.,PNU BK21 Plus Biomedical Science Education Center, Pusan National University, School of Medicine, Yangsan, South Korea
| | - Hyeon-Jeong Lee
- Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Pusan National University, School of Medicine, Busan, South Korea
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Zhao J, Kang Z, Xie W, Lin H, Liu Y. Effects of Depth of Anesthesia Monitored by IoC on Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer. Mol Ther Methods Clin Dev 2020; 18:304-311. [PMID: 32637458 PMCID: PMC7330423 DOI: 10.1016/j.omtm.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
Index of consciousness (IoC) consisting of IoC1 and IoC2, is a new analgesia monitoring indicator in anesthesia evaluation in the laparoscopic radical resection of colorectal cancer. Although the precise anesthetic dosage adjusted by IoC1 has been confirmed to enhance the recovery and reduce the complications of anesthesia, the most appropriate range of IoC2 during anesthesia remains unclear. To investigate the correlation between IoC2 and peri-operative indicators of patients during laparoscopic radical resection of colorectal cancer, the current randomized, controlled, and single-blinded clinical trial was performed. Participants were divided randomly into three groups with different anesthesia depth monitored by IoC2 during their laparoscopic radical resections. Primary outcomes included the dosage of remifentanil. Secondary outcomes included other physiological indexes and complications. The remifentanil dosage and the awakening time increased as IoC2 decreased. The incidences of hypotension and hypoxemia decreased with the elevated IoC2, but the risk of intra-operative awareness also increased. The impact caused by anesthesia to the immune system and health-related life quality of the patients descended with reduced anesthetic level. The IoC2 range of 35–45 could represent the most appropriate anesthetic depth during laparoscopic radical resection, which provides a new perspective for the clinical treatment of colon cancer.
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Abstract
Background
The effect of anesthetic drugs on cancer outcomes remains unclear. This trial aimed to assess postoperative circulating tumor cell counts—an independent prognostic factor for breast cancer—to determine how anesthesia may indirectly affect prognosis. It was hypothesized that patients receiving sevoflurane would have higher postoperative tumor cell counts.
Methods
The parallel, randomized controlled trial was conducted in two centers in Switzerland. Patients aged 18 to 85 yr without metastases and scheduled for primary breast cancer surgery were eligible. The patients were randomly assigned to either sevoflurane or propofol anesthesia. The patients and outcome assessors were blinded. The primary outcome was circulating tumor cell counts over time, assessed at three time points postoperatively (0, 48, and 72 h) by the CellSearch assay. Secondary outcomes included maximal circulating tumor cells value, positivity (cutoff: at least 1 and at least 5 tumor cells/7.5 ml blood), and the association between natural killer cell activity and tumor cell counts. This trial was registered with ClinicalTrials.gov (NCT02005770).
Results
Between March 2014 and April 2018, 210 participants were enrolled, assigned to sevoflurane (n = 107) or propofol (n = 103) anesthesia, and eventually included in the analysis. Anesthesia type did not affect circulating tumor cell counts over time (median circulating tumor cell count [interquartile range]; for propofol: 1 [0 to 4] at 0 h, 1 [0 to 2] at 48 h, and 0 [0 to 1] at 72 h; and for sevoflurane: 1 [0 to 4] at 0 h, 0 [0 to 2] at 48 h, and 1 [0 to 2] at 72 h; rate ratio, 1.27 [95% CI, 0.95 to 1.71]; P = 0.103) or positivity. In one secondary analysis, administrating sevoflurane led to a significant increase in maximal tumor cell counts postoperatively. There was no association between natural killer cell activity and circulating tumor cell counts.
Conclusions
In this randomized controlled trial investigating the effect of anesthesia on an independent prognostic factor for breast cancer, there was no difference between sevoflurane and propofol with respect to circulating tumor cell counts over time.
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