Outpatient breast-conserving surgery for breast cancer: Use of local and intravenous anesthesia and/or sedation may reduce recurrence and improve survival

Kim, Ryungsa; Kawai, Ami; Wakisaka, Megumi; Sawada, Sayaka; Shimoyama, Mika; Yasuda, Naomi; Kin, Takanori; Arihiro, Koji

doi:10.1016/j.amsu.2020.10.072

Cited by 10 publications

(14 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have reported that the serum level of VEGF-C in patients undergoing breast cancer surgery and general anesthesia is higher than in patients undergoing paravertebral block, but the level of TGF-β is lower; these changes may be adverse to the long-term prognosis of cancer patients (8). Inhalation of general anesthetics can inhibit NK cell activity by inhibiting interferon production, increasing the probability of metastasis and tumor cell recurrence (6). Sevoflurane may also increase the risk of new malignant diseases in cancer patients up to 5 years after surgery (3).…”

Section: Effect Of General Anesthesia On the Long-term Prognosis Of Patients With Breast Cancermentioning

confidence: 99%

“…Large doses of opioids have been reported to induce immunosuppression in cell culture experiments and animal models (3,4). However, some researchers believe that opioids during surgery improve disease-free survival of triple negative breast cancer (5), and spinal anesthesia and local anesthesia can prevent immunosuppression during the perioperative period (6). Other perioperative conditions, including blood transfusions, pain, stress, and hypothermia, are also potentially important factors interfering with perioperative immunity (2).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

Liu

Wang

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

Background: Breast cancer is currently the leading cause of women's death. It is crucial to further improve the approach to treatment and the long-term survival rate of breast cancer patients, and to reduce the rates of recurrence and metastasis. It has been reported that the possibility of tumor metastasis depends on the metastatic potential of the tumor and the host defense against tumor metastasis, in which cellular immunity and the function of natural killer (NK) cells are critical to maintaining this balance. Surgical stress response and postoperative pain inhibit perioperative immune function in patients and increase the likelihood of dissemination and metastasis of cancer cells after cancer surgery. The study aims to investigate the effect of anesthetic factors and pain treatment on the long-term prognosis of patients with early stage lymph node negative breast preservation surgery.Methods: A total of 337 patients with early-stage lymph node negative breast cancer (ASA I-II) who had undergone successful breast-conserving surgery in our hospital were included in this retrospective analysis.Cases were divided into general anesthesia with postoperative analgesia group (GA + PCA), general anesthesia without postoperative analgesia group (GA), epidural anesthesia with postoperative analgesia group (EA + PCA), and epidural anesthesia without postoperative analgesia group (EA). The 5-year survival rate and 5-year disease-free survival were recorded in the 4 groups.Results: The general condition and length of hospital stay of the patients were not statistically different between the 4 groups. However, the 5-year survival rate and 5-year disease-free survival rate of the 4 groups were statistically different. The 5-year survival rate and 5-year disease-free survival rate were the lowest in the GA group, while the EA + PCA group had the highest 5-year disease-free survival rate. The 5-year survival rate and 5-year disease-free survival rate in the GA + PCA group were significantly higher than those in the GA group. The 5-year disease-free survival rate in EA group was significantly higher than GA group.Conclusions: Epidural anesthesia and postoperative pain treatment maybe beneficial to the long-term prognosis of patients with early-stage lymph node-negative breast cancer.

show abstract

Section: Effect Of General Anesthesia On the Long-term Prognosis Of Patients With Breast Cancermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

Liu

Wang

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…Non-intubated metastasectomy with video-assisted thoracic surgery induces fewer inflammatory and immune reactions than does conventional surgery with intubation under GA ( 82 ). Moreover, with the de-escalation of breast cancer surgery, outpatient procedures can be performed without mechanical ventilation, with the use of lidocaine LA, low-dose propofol IVA, and/or midazolam sedation, which may reduce the recurrence rate; however, this evidence derives from retrospective cohort studies, not studies involving comparison with alternative anesthetic techniques such as standard GA ( 83 , 84 ). In addition, awake surgery for breast cancer with LA causes less postoperative lymphopenia and may reduce the risk of tumor progression relative to GA ( 7 ).…”

Section: Effects Of Surgical Stress and Anesthesia On Immune Function...mentioning

confidence: 99%

Current Status and Prospects of Anesthesia and Breast Cancer: Does Anesthetic Technique Affect Recurrence and Survival Rates in Breast Cancer Surgery?

Kim¹,

Kawai²,

Wakisaka³

et al. 2022

Front. Oncol.

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…In contrast, the use of IV anesthesia with low-dose propofol and/or sedation with midazolam without opioids under the maintenance of spontaneous breathing can reduce anesthetic-related immunosuppression. The latter anesthetic technique may improve survival by reducing the recurrence of breast cancer through the maintenance of antitumor immunity after surgical treatment [ 87 ]. A prospective RCT examining the effects of BCS performed with and without spontaneous breathing and opioids in patients with breast cancer is needed.…”

Section: Host Defense Immunity and Breast Cancer Recurrencementioning

confidence: 99%

Clinical Perspectives in Addressing Unsolved Issues in (Neo)Adjuvant Therapy for Primary Breast Cancer

Kim¹,

Kin

2021

Cancers

Self Cite

View full text Add to dashboard Cite

The treatment of primary breast cancer has evolved over the past 50 years based on the concept that breast cancer is a systemic disease, with the escalation of adjuvant and neoadjuvant therapies and de-escalation of breast cancer surgery. Despite the development of these therapies, recurrence with distant metastasis during the 10 years after surgical treatment is observed, albeit infrequently. Recent advances in genomic analysis based on circulating tumor cells and circulating tumor DNA have enabled the development of targeted therapies based on genetic mutations in residual tumor cells. A paradigm shift involving the application of neoadjuvant chemotherapy (NAC) has enabled the prediction of treatment response and long-term prognoses; additional adjuvant chemotherapy targeting remaining tumor cells after NAC improves survival. The activation of antitumor immunity by anticancer agents may be involved in the eradication of residual tumor cells. Elucidation of the manner in which antitumor immunity is induced by anticancer agents and unknown factors, and the overcoming of drug resistance via the targeted eradication of residual tumor cells based on genomic profiles, will inevitably lead to the achievement of 0% distant recurrence and a complete cure for primary breast cancer.

show abstract

Outpatient breast-conserving surgery for breast cancer: Use of local and intravenous anesthesia and/or sedation may reduce recurrence and improve survival

Cited by 10 publications

References 32 publications

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

Current Status and Prospects of Anesthesia and Breast Cancer: Does Anesthetic Technique Affect Recurrence and Survival Rates in Breast Cancer Surgery?

Clinical Perspectives in Addressing Unsolved Issues in (Neo)Adjuvant Therapy for Primary Breast Cancer

Contact Info

Product

Resources

About