rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-4-20-28rmt-2250Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERВлияние выбора метода анестезии на иммунный ответ пациенток, перенесших радикальную операцию по поводу рака молочной железы (мета-анализ сравнительных клинических исследований)Impact of Anesthesia Method on Immune Response in Patients Undergoing Radical Surgery for Breast Cancer (a Meta-Analysis of Comparative Clinical Studies)ЛихванцевВ. В.LikhvantsevV. V.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

111991, г. Москва, 2-я Трубецкая ул. д. 8

Valery V. Likhvantsev

25 Petrovka Str., Bldg. 2, 107031 Moscow

8 Trubetskaya Str., Bldg. 2, 119991 Moscow

ЛандониДж.LandoniG.

20132, г. Милан, Виа Олгиттина, д. 60

20132, г. Милан, Виа Олгиттина д. 58

Giovanni Landoni

60 Via Olgettina, 20132 Milan

58 Via Olgettina, 12132 Milan

СубботинВ. В.SubbotinV. V.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Valery V. Subbotin

25 Petrovka Str., Bldg. 2, 107031 Moscow

 

КаданцеваК. К.KadantsevaK. K.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

111123, г. Москва, Шоссе Энтузиастов, д. 86

Kristina K. Kadantseva

25 Petrovka Str., Bldg. 2, 107031 Moscow

86 Enthusiasts Highway, 111123 Moscow

ЖуковаЛ. А.ZhukovaL. A.

111123, г. Москва, Шоссе Энтузиастов, д. 86

Ludmila A. Zhukova

86 Enthusiasts Highway, 111123 Moscow

ЯдгаровМ. Я.YadgarovM. Ya.

Михаил Яковлевич Ядгаров

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Mikhail Ya. Yadgarov

25 Petrovka Str., Bldg. 2, 107031 Moscow

mikhail.yadgarov@mail.ruБелеттиА.BelettiA.

20132, г. Милан, Виа Олгиттина, д. 60

Alessandro Beletti

60 Via Olgettina, 20132 Milan

НовиковА. А.NovikovA. A.

111123, г. Москва, Шоссе Энтузиастов, д. 86

Alexander A. Novikov

86 Enthusiasts Highway, 111123 Moscow

БерикашвилиЛ. Б.BerikashviliL. B.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Levan B. Berikashvili

25 Petrovka Str., Bldg. 2, 107031 Moscow

КузовлевА. Н.KuzovlevA. N.

107031, г. Москва, ул. Петровка, д. 25, стр. 2

Artem N. Kuzovlev

25 Petrovka Str., Bldg. 2, 107031 Moscow

НИИ Общей реаниматологии им. В. А. Неговского ФНКЦ РР; Первый Московский Государственный медицинский университет им. И. М. СеченоваРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology; I. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian FederationОтдел анестезиологии и интенсивной терапии, Научный институт Сан-Рафаэле; Университет Вита-Салюте Сан-РаффаэлеИталияDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele UniversityItalyНИИ Общей реаниматологии им. В. А. Неговского ФНКЦ РРРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian FederationНИИ Общей реаниматологии им. В. А. Неговского ФНКЦ РР; Московский клинический научный центр им. А. С. Логинова Департамента здравоохранения г. МосквыРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology; A. S. Loginov Moscow Clinical Research Center, Moscow Department of HealthRussian FederationМосковский клинический научный центр им. А. С. Логинова Департамента здравоохранения г. МосквыРоссияA. S. Loginov Moscow Clinical Research Center, Moscow Department of HealthRussian FederationОтдел анестезиологии и интенсивной терапии, Научный институт Сан-РафаэлеИталияDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific InstituteItaly20222508202218420–28Copyright © Лихванцев В.В., Ландони Д., Субботин В.В., Каданцева К.К., Жукова Л.А., Ядгаров М.Я., Белетти А., Новиков А.А., Берикашвили Л.Б., Кузовлев А.Н., 20222022Лихванцев В.В., Ландони Д., Субботин В.В., Каданцева К.К., Жукова Л.А., Ядгаров М.Я., Белетти А., Новиков А.А., Берикашвили Л.Б., Кузовлев А.Н.Likhvantsev V.V., Landoni G., Subbotin V.V., Kadantseva K.K., Zhukova L.A., Yadgarov M.Y., Beletti A., Novikov A.A., Berikashvili L.B., Kuzovlev A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2250

Последние данные свидетельствуют о том, что ингаляционная анестезия (ИА) связана с более высокой летальностью от рака по сравнению с тотальной внутривенной анестезией (ТВА), возможно, из-за модуляции иммунного ответа.

Цель

Цель. В связи с появлением данных о возможном влиянии выбора метода анестезии на иммунный статус и, как следствие, развитие рецидивов злокачественных новообразований, целью настоящего исследования стало определение влияния выбора метода анестезии на некоторые параметры иммунитета пациенток.

Методы

Методы. Провели мета-анализ клинических исследований, опубликованных в базах данных PubMed, Google Scholar и Cochrane и направленных на оценку влияния анестезии на послеоперационный иммунный статус больных, перенесших операцию по поводу рака молочной железы (РМЖ). Включили пять рандомизированных и три обсервационных исследования (всего с участием 637 пациенток, из них 320 (50,2%) в группе ТВА). Извлекли данные о содержании лейкоцитов, матриксных металлопротеиназ (ММП)-9 и -3, интерлейкинов (ИЛ)-6 и -10 и нейтрофильно-лимфоцитарного индекса (НЛИ).

Результаты

Результаты. Пациентки с операцией по поводу РМЖ, перенесшие ТВА, имели значительно более низкое содержание лейкоцитов (стандартизованная разница средних (SMD)=-0,32; 95% доверительный интервал (ДИ): –0,58 — –0,06; I2=58%, P=0,020) и ММП-9 (SMD=–0,35; 95% ДИ: –0,67 — –0,03; p=0,030; I2=0%) в послеоперационном периоде по сравнению с больными, получавшими ИА. Концентрации ММП-3, ИЛ-6, ИЛ-10 и НЛИ статистически значимо не отличались в двух группах.

Заключение

Заключение. У пациенток, перенесших операцию по поводу РМЖ в условиях ТВА, обнаружили более низкое содержание лейкоцитов крови и фермента, участвующего в ремоделировании структур внеклеточного матрикса — ММП-9 по сравнению с пациентками, оперированными в условиях ИА, что может свидетельствовать о возможном влиянии выбора метода анестезии на иммунитет пациенток с РМЖ.

Introduction and aim

Introduction and aim. Recent evidence suggests that inhalation anesthesia (IA) is associated with higher cancer mortality than total intravenous anesthesia (TIVA), possibly due to a modulation of the immune response.

The aim of this study was to determine the impact of anesthesia techniques on selected parameters of patient immunity considering the evidence of relationship between the anesthesia methods and immune status and, consequently, the incidence of cancer recurrence.

Methods

Methods. We performed a meta-analysis of clinical studies published in PubMed, Google Scholar, and Cochrane databases, aimed at assessing the impact of anesthesia on the postoperative immune status of patients undergoing breast cancer (BC) surgery. Five randomized and three observational studies were included (a total of 637 patients, of which 320 (50.2%) in the TIVA group). Data on leukocyte counts, matrix metalloproteinases (MMP) 9 and 3, interleukins (IL) 6 and 10 levels, and neutrophil-lymphocyte index (NLI) values were retrieved.

Results

Results. Patients after breast cancer surgery who underwent TIVA had significantly lower white blood cell counts (standardized mean difference (SMD)=–0.32; 95% CI: –0.58 to –0.06; I2=58%, P=0.020) and MMP-9 (SMD=–0.35; 95% CI: –0.67 to –0.03; P=0.030; I2=0%) in the postoperative period compared with patients receiving IA. No significant differences in the levels of MMP-3, IL-6, IL-10, and NLI values were found between the two groups.

Conclusion

Conclusion. The patients who underwent breast cancer surgery under TIVA had lower blood leukocyte counts and levels of MMP-9, which is involved in the remodeling of extracellular matrix, compared with those operated on under IA, suggesting that the anesthesia method may have an impact on the immunity of breast cancer patients.

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The authors declare that there are no conflicts of interest present.