Preview

General Reanimatology

Advanced search

Impact of Anesthesia Method on Immune Response in Patients Undergoing Radical Surgery for Breast Cancer (a Meta-Analysis of Comparative Clinical Studies)

https://doi.org/10.15360/1813-9779-2022-4-20-28

Abstract

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. 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. 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. 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.

About the Authors

V. V. Likhvantsev
V. 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 Russia
Russian Federation

Valery V. Likhvantsev

25 Petrovka Str., Bldg. 2, 107031 Moscow

8 Trubetskaya Str., Bldg. 2, 119991 Moscow



G. Landoni
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University
Italy

Giovanni Landoni

60 Via Olgettina, 20132 Milan

58 Via Olgettina, 12132 Milan



V. V. Subbotin
V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation

Valery V. Subbotin

25 Petrovka Str., Bldg. 2, 107031 Moscow

 



K. K. Kadantseva
V. 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 Health
Russian Federation

Kristina K. Kadantseva

25 Petrovka Str., Bldg. 2, 107031 Moscow

86 Enthusiasts Highway, 111123 Moscow



L. A. Zhukova
A. S. Loginov Moscow Clinical Research Center, Moscow Department of Health
Russian Federation

Ludmila A. Zhukova

86 Enthusiasts Highway, 111123 Moscow



M. Ya. Yadgarov
V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation

Mikhail Ya. Yadgarov

25 Petrovka Str., Bldg. 2, 107031 Moscow



A. Beletti
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute
Italy

Alessandro Beletti

60 Via Olgettina, 20132 Milan



A. A. Novikov
A. S. Loginov Moscow Clinical Research Center, Moscow Department of Health
Russian Federation

Alexander A. Novikov

86 Enthusiasts Highway, 111123 Moscow



L. B. Berikashvili
V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation

Levan B. Berikashvili

25 Petrovka Str., Bldg. 2, 107031 Moscow



A. N. Kuzovlev
V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation

Artem N. Kuzovlev

25 Petrovka Str., Bldg. 2, 107031 Moscow



References

1. Tsimberidou A.M., Fountzilas E., Nikanjam M., Kurzrock R. Review of precision cancer medicine: evolution of the treatment paradigm. Cancer Treat Rev. 2020; 86: 102019. DOI: 10.1016/j.ctrv.2020.102019. PMID: 32251926.

2. Zaimy M.A., Saffarzadeh N., Mohammadi A., Pourghadamyari H., Izadi P., Sarli A., Moghaddam LK., Paschepari SR., Azizi H., Torkamandi S., Tavakkoly-Bazzaz J. New methods in the diagnosis of cancer and gene therapy of cancer based on nanoparticles. Cancer Gene Ther. 2017; 24 (6): 233–243. DOI: 10.1038/cgt.2017.16. PMID: 28574057.

3. Sullivan R., Alatise O.I., Anderson B.O., Audisio R., Autier P., Aggarwal A., Balch C., Brennan M.F., Dare A., D'Cruz A., Eggermont A.M., Fleming K., Gueye S.M., Hagander L., Herrera C.A., Holmer H., Ilbawi A.M., Jarnheimer A., Ji J.F., Kingham T.P., Liberman J., Leather A.J.M., Meara J.G., Mukhopadhyay S., Murthy S.S., Omar S., Parham G.P., Pramesh C.S., Riviello R., Rodin D., Santini L., Shrikhande S.V., Shrime M., Thomas R., Tsunoda A.T., van de Velde C., Veronesi U., Vijaykumar D.K., Watters D., Wang S., Wu Y-L., Zeiton M., Purushotham A. Global cancer surgery: delivering safe., affordable., and timely cancer surgery. Lancet Oncol. 2015; 16 (11): 1193–1224. DOI: 10.1016/S1470-2045(15)00223-5. PMID: 26427363.

4. Soltanizadeh S., Degett T.H., Gögenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: a systematic review. J Clin Anesth. 2017; 42: 19–25. DOI: 10.1016/j.jclinane.2017.08.001. PMID: 28797751.

5. Snyder G.L., Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010; 105 (2): 106–115. DOI: 10.1093/bja/aeq164. PMID: 20627881.

6. Adams J.M., Cory S. The Bcl-2 apoptotic switch in cancer development and therapy. Oncogene. 2007; 26 (9): 1324–1337. DOI: 10.1038/sj.onc.1210220. PMID: 17322918.

7. Jaura A.I., Flood G., Gallagher H.C., Buggy D.J. Differential effects of serum from patients administered distinct anaesthetic techniques on apoptosis in breast cancer cells in vitro: a pilot study. Br J Anaesth. 2014; 113 (Suppl 1): i63–7. DOI: 10.1093/bja/aet581. PMID: 25009197.

8. Yan T., Zhang G-H., Wang B-N., Sun L., Zheng H. Effects of propofol/remifentanil-based total intravenous anesthesia versus sevoflurane-based inhalational anesthesia on the release of VEGF-C and TGF-β and prognosis after breast cancer surgery: a prospective, randomized and controlled study. BMC Anesthesiol. 2018; 18 (1): 131. DOI: 10.1186/s12871-018-0588-3. PMID: 30243294.

9. Likhvantsev V., Yadgarov M., Di Piazza M., Kadantseva K. Inhalation vs total intravenous anesthesia in cancer surgery: where is the «pendulum» now? (meta-analysis and review). General Reanimatology. 2020; 16 (6): 91–104. DOI: 10.15360/1813-9779-2020-6-91-104.

10. Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis J.P., Clarke M., Devereaux P.J., Kleijnen J., Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6 (7): e1000100. DOI: 10.1371/journal.pmed.1000100. PMID: 19621070.

11. Moher D., Liberati A., Tetzlaff J., Altman D.G., PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6 (7): e1000097. DOI: 10.1371/journal.pmed.1000097. PMID: 19621072.

12. Dixon E., Hameed M., Sutherland F., Cook D.J., Doig C. Evaluating meta-analyses in the general surgical literature: a critical appraisal. Ann Surg. 2005; 241 (3): 450–459. DOI: 10.1097/01.sla.0000154258.30305.df. PMID: 15729067.

13. Young C., Horton R. Putting clinical trials into context. Lancet. 2005; 366 (9480): 107–108. DOI: 10.1016/S0140-6736 (05)66846-8. PMID: 16005318

14. Higgins J. P.T., Thomas J., Chandler J., Cumpston M., Li T., Page M. J., Welch V.A. (eds.). Cochrane handbook for systematic reviews of interventions. 2nd Edition. Chichester (UK). John Wiley & Sons; 2019: 1–694.

15. Wan X., Wang W., Liu J., Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014; 14: 135. DOI: 10.1186/1471-2288-14-135. PMID: 25524443.

16. Borenstein M. Introduction to meta-analysis. John Wiley & Sons; 2011: 1-450.Borenstein M., Hedges L.V., Higgins J.P.T., Rothstein H.R. Introduction to Meta-Analysis, 2nd Edition. John Wiley & Sons; 2021: 1–544. ISBN: 978-1-119-55835-4.

17. Sterne J.A.C., Savović J., Page M.J., Elbers R.G., Blencowe N.S., Boutron I., Cates C.J., Cheng H-Y., Corbett M.S., Eldridge S.M., Emberson J.R., Hernán M.A., Hopewell S., Hróbjartsson A., Junqueira D.R., Jüni P., Kirkham J.J., Lasserson T., Li T., McAleenan A., Reeves B.C., Shepperd S., Shrier I., Stewart L.A., Tilling K., White I.R., Whiting P.F., Higgins J.P.T. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366: l4898. DOI: 10.1136/bmj.l4898. PMID: 31462531.

18. Sterne J.Ac., Hernán M.A., Reeves B.C., Savović J., Berkman N.D., Viswanathan M., Henry D., Altman D.G., Ansari M.T., Boutron I., Carpenter J.R., Chan A-W., Churchill R., Deeks J.J., Hróbjartsson A., Kirkham J., Jüni P., Loke Y.K., Pigott T.D., Ramsay C.R., Regidor D., Rothstein H.R., Sandhu L., Santaguida P.L., Schünemann H.J., Shea B., Shrier I., Tugwell P., Turner L., Valentine J.C., Waddington H., Waters E., Wells G.A., Whiting P.F., Higgins J.P. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355: i4919. DOI: 10.1136/bmj.i4919. PMID: 27733354.

19. Egger M., Davey Smith G., Schneider M., Minder C. Bias in metaanalysis detected by a simple, graphical test. BMJ. 1997; 315 (7109): 629–634. DOI: 10.1136/bmj.315.7109.629. PMID: 9310563.

20. Begg C.B., Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50 (4): 1088–1101. PMID: 7786990

21. Sterne J.A., Sutton A.J., Ioannidis J.P., Terrin N., Jones D.R., Lau J., Carpenter J., Rücker G., Harbord R.M., Schmid C.H., Tetzlaff J., Deeks J.J., Peters J., Macaskill P., Schwarzer G., Duval S., Altman D.G., Moher D., Higgins J.P. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011; 343: d4002. DOI: 10.1136/bmj.d4002. PMID: 21784880.

22. Kim R., Kawai A., Wakisaka M., Funaoka Y., Ohtani S., Ito M., Kadoya T., Okada M. Differences in immune response to anesthetics used for day surgery versus hospitalization surgery for breast cancer patients. Clin Transl Med. 2017; 6 (1): 34. DOI: 10.1186/s40169-017-0163-4. PMID: 28905322.

23. Deegan C.A., Murray D., Doran P., Moriarty D.C., Sessler D.I., Mascha E., Kavanagh B.P., Buggy D.J. Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery. Reg Anesth Pain Med. 2010; 35 (6): 490–495. DOI: 10.1097/AAP.0b013e3181ef4d05. PMID: 20975461.

24. Cho J.S., Lee M.-H., Kim S.I., Park S.H., Park H.S., Oh E., Lee J.H., Koo B.-N. The effects of perioperative anesthesia and analgesia on immune function in patients undergoing breast cancer resection: a prospective randomized study. Int J Med Sci. 2017; 14 (10): 970–976. DOI: 10.7150/ijms.20064. PMID: 28924368.

25. Eochagáin A.N., Burns D., Riedel B., Sessler D.I., Buggy D.J. The effect of anaesthetic technique during primary breast cancer surgery on neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and return to intended oncological therapy. Anaesthesia. 2018; 73 (5): 603–611. DOI: 10.1111/anae.14207. PMID: 29457215.

26. Oh C.-S., Lee J., Yoon T.-G., Seo E.-H., Park H.-J., Piao L., Lee S.-H., Kim S.-H. Effect of equipotent doses of propofol versus sevoflurane anesthesia on regulatory T cells after breast cancer surgery. Anesthesiology. 2018; 129 (5): 921–931. DOI: 10.1097/ALN.0000000000002382. PMID: 30074934.

27. Lim J.-A., Oh C.-S., Yoon T.-G., Lee J.Y., Lee S.-H., Yoo Y.-B., Yang J.-H., Kim S.-H. The effect of propofol and sevoflurane on cancer cell, natural killer cell, and cytotoxic T lymphocyte function in patients undergoing breast cancer surgery: an in vitro analysis. BMC Cancer. 2018; 18 (1): 159. DOI: 10.1186/s12885-018-4064-8. PMID: 29415668.

28. Woo J.H., Baik H.J., Kim C.H., Chung R.K., Kim D.Y., Lee G.Y., Chun E.H. Effect of propofol and desflurane on immune cell populations in breast cancer patients: a randomized trial. J Korean Med Sci. 2015; 30 (10): 1503–1508. DOI: 10.3346/jkms.2015.30.10.1503. PMID: 26425050.

29. Galoș E.V., Tat T.-F., Popa R., Efrimescu C.-I., Finnerty D., Buggy D.J., Ionescu D.C., Mihu C.M. Neutrophil extracellular trapping and angiogenesis biomarkers after intravenous or inhalation anaesthesia with or without intravenous lidocaine for breast cancer surgery: a prospective, randomised trial. Br J Anaesth. 2020; 125 (5): 712–721. DOI: 10.1016/j.bja.2020.05.003. PMID: 32616309.

30. Enlund M., Berglund A., Andreasson K., Cicek C., Enlund A., Bergkvist L. The choice of anaesthetic — sevoflurane or propofol — and outcome from cancer surgery: a retrospective analysis. Ups J Med Sci. 2014; 119 (3): 251–261. DOI: 10.3109/03009734.2014.922649. PMID: 24857018.

31. Wigmore T.J., Mohammed K., Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology. 2016; 124 (1): 69–79. DOI: 10.1097/ALN.0000000000000936. PMID: 26556730.

32. Kim M.H., Kim D.W., Kim J.H., Lee K.Y., Park S., Yoo Y.C. Does the type of anesthesia really affect the recurrence-free survival after breast cancer surgery? Oncotarget. 2017; 8 (52): 90477–90487. DOI: 10.18632/oncotarget.21014. PMID: 29163846.

33. Yap A., Lopez-Olivo M.A., Dubowitz J., Hiller J., Riedel B; Global OncoAnesthesia Research Collaboration Group. Anesthetic technique and cancer outcomes: a meta-analysis of total intravenous versus volatile anesthesia. Can J Anaesth. 2019; 66 (5): 546–561. DOI: 10.1007/s12630-019-01330-x. PMID: 30834506.

34. Pang Q.-Y., Duan L.-P., Jiang Y., Liu H.-L. 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. DOI: 10.2147/JPR.S315360. PMID: 34295185.

35. Leifler K.S., Svensson S., Abrahamsson A., Bendrik C., Robertson J., Gauldie J., Olsson A.-K., Dabrosin C. Inflammation induced by MMP- 9 enhances tumor regression of experimental breast cancer. J Immunol. 2013; 190 (8): 4420–4430. DOI: 10.4049/jimmunol.1202610. PMID: 23509357.

36. Song J., Su H., Zhou Y.-Y., Guo L-.L. Prognostic value of matrix metalloproteinase 9 expression in breast cancer patients: a meta-analysis. Asian Pac J Cancer Prev. 2013; 14 (3): 1615–1621. DOI: 10.7314/apjcp.2013.14.3.1615. PMID: 23679245.

37. Ren F., Tang R., Zhang X., Madushi W.M., Luo D., Dang Y., Li Z., Wei K., Chen G. Overexpression of MMP family members functions as prognostic biomarker for breast cancer patients: a systematic review and meta-analysis. PLoS One. 2015; 10 (8): e0135544. DOI: 10.1371/journal.pone.0135544. PMID: 26270045.

38. Baiardo Redaelli M., Belletti A., Monti G., Lembo R., Ortalda A., Landoni G., Bellomo R. The impact of non-blinding in critical care medicine trials. J Crit Care. 2018; 48: 414–417. DOI: 10.1016/j.jcrc.2018.09.031. PMID: 30317050.

39. Baiardo Redaelli M., Landoni G., Di Sanzo S., Frassoni S., Sartini C., Cabrini L., Monti G., Scandroglio M., Zangrillo A., Bellomo R. Interventions affecting mortality in critically ill and perioperative patients: a systematic review of contemporary trials. J Crit Care. 2017; 41: 107–111. DOI: 10.1016/j.jcrc.2017.05.005. PMID: 28505485


Review

For citations:


Likhvantsev V.V., Landoni G., Subbotin V.V., Kadantseva K.K., Zhukova L.A., Yadgarov M.Ya., Beletti A., Novikov A.A., Berikashvili L.B., Kuzovlev A.N. Impact of Anesthesia Method on Immune Response in Patients Undergoing Radical Surgery for Breast Cancer (a Meta-Analysis of Comparative Clinical Studies). General Reanimatology. 2022;18(4):20–28. https://doi.org/10.15360/1813-9779-2022-4-20-28

Views: 862


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1813-9779 (Print)
ISSN 2411-7110 (Online)