Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques.

INTRODUCTION: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. METHODS: A prospective, comparative and non- randomised study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48 h after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. RESULTS: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks. We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48 h after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). CONCLUSIONS: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.

Respuesta inmunológica en cirugía del cáncer de mama. Estudio comparativo y prospectivo de diferentes técnicas anestésicas / Immune response in breast cancer surgery. A comparative and prospective study of different anesthetic techniques

Introducción: El principal motivo de la alta mortalidad en el cáncer de mama es la recurrencia local y las metástasis, siendo la cirugía la primera opción terapéutica. La técnica anestésica utilizada en quirófano puede modificar la respuesta inmunológica del paciente. Métodos: Estudio prospectivo, comparativo y no aleatorizado en pacientes intervenidos de cáncer de mama en el Hospital Universitario de Getafe (Madrid) tras la aprobación del Comité Ético del Hospital.Dividimos a los pacientes en dos grupos: grupo A, que recibió anestesia general con propofol y fármacos opiáceos; grupo B, en el que además de la anestesia general, se realizaron tres bloqueos interfasciales (Pec I, Pec II y BRILMA) en todos los pacientes. Se obtuvieron tres muestras sanguíneas: 1) antes de la inducción anestésica; 2) 2h después de finalizar la cirugía y 3) 24-48h posquirúrgicas. En cada muestra, se analizaron el número de leucocitos, células CD3, CD4 y CD8, así como las células natural killer (NK). Resultados: Se incluyeron en el estudio un total de 103 pacientes; 59 (grupo A) recibieron anestesia general y 54 (grupo B) anestesia general y bloqueos interfasciales. Según las características basales, la edad fue significativamente superior en las pacientes que recibieron anestesia general. La mastectomía se realizó con más frecuencia en el grupo que recibió bloqueos interfasciales. Observamos que después de la cirugía hay un aumento en el número de leucocitos pero regresa a los niveles basales a las 48h, comportamiento que se repite a nivel inmunológico: disminuye después de la cirugía pero vuelve a niveles previos a las 48h de la cirugía. Los grupos A y B presentan resultados similares en el resto de parámetros estudiados, al igual que los subgrupos según los receptores hormonales (HER+, PR y/o ER+).(AU)

Introduction: The main reason for high mortality in breast cancer is local recurrence and metastasis, despite surgery as the first therapeutic option. The anesthesia used in the operation room can determine the immune response. Methods: A prospective, comparative and non-randomized study in patients undergoing breast cancer surgery was conducted in our hospital after obtaining approval from the Hospital's Institutional Review Board. Patients were divided in two groups: Group A received general anesthesia with propofol and opioids. Group B, in addition to general anesthesia, three interfascial blocks (Pec I, Pec II and BRILMA) were performed in all patients. Three blood samples were taken 1) previous anesthetic induction; 2) two hours after the end of the surgery and 3) 24-48hours after surgery. Leukocytes, CD3, CD4, CD8 and Natural Killer cells were determined at each time. Results: 103 patients were included. 59 (group A) received general anesthesia and 54 (group B) general anesthesia and interfascial blocks. Regarding baseline characteristics, age was significantly higher in the group that received general anesthesia and mastectomy was more frequent in the group that received interfascial blocks.We observed after surgery an increase in leukocytes level that returns close to baseline levels. On the other hand, a reduction in the immune response was observed that also returns to the previous level 48hours after surgery. Group A and B get similar results and also subgroups of hormonal receptors (HER+, PR and/or ER+). Conclusions: Interfascial blocks in chest wall added to general anesthesia in breast cancer surgery has not shown a significant difference in the inflammatory response or immunological depression compared to general anesthesia as the only anesthetic technique. It seems to trend less immunological depression in the interfascial block group.(AU)