The impact of anesthetic techniques on breast cancer recurrence
a systematic review of clinical evidence
Keywords:
breast neoplasms, recurrence, anesthesiaAbstract
Introduction: Surgery is the most effective treatment for breast cancer; however, several factors can impair the immune system during the perioperative period, including the anesthetic technique. Since metastasis is the leading cause of death, one of the treatment pillars is to prevent cancer progression. This systematic review will focus on the prospective clinical evidence available on anesthesia’s role in favoring breast cancer recurrence. Methods: The Cochrane Library, Medline, Embase, LILACs, and Web of Science were electronically searched from inception through December 2020 for randomized controlled trials assessing the association of postoperative recurrence and survival with the use of regional anesthesia, opioids, anesthetic adjuncts, and general anesthesia during surgical resection of breast cancer. In total, 711 articles were retrieved. After title and abstract screening and full-text reviews, five randomized controlled trials were selected. Results: Two studies compared inhalation anesthesia with total intravenous anesthesia, while three compared general anesthesia with regional anesthesia and analgesia. There was no significant association between the anesthetic technique and local recurrence, metastasis, or survival. Conclusion: This systematic review did not find an association between the type of anesthesia performed and a higher breast cancer recurrence rate. Up to this time, there is no clinical evidence to support a specific anesthetic technique for malignant breast tumor resection surgeries.
Downloads
References
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. https://doi.org/10.1002/ijc.29210
Ghoncheh M, Pournamdar Z, Salehiniya H. Incidence and Mortality and Epidemiology of Breast Cancer in the World. Asian Pac J Cancer Prev. 2016;17(S3):43-6. https://doi.org/10.7314/apjcp.2016.17.s3.43
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. (eds.). Cancer Statistics Review, 1975-2015 - SEER Statistics. Bethesda: National Cancer Institute; 2018.
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271-89. https://doi.org/10.3322/caac.21349
Eden C, Esses G, Katz D, DeMaria Jr. S. Effects of anesthetic interventions on breast cancer behavior, cancer-related patient outcomes, and postoperative recovery. Surg Oncol. 2018;27(2):266-74. https://dx.doi.org/10.1016%2Fj. suronc.2018.05.001
Horowitz M, Neeman E, Sharon E, Ben-Eliyahu S. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nat Rev Clin Oncol. 2015;12(4):213-26. https://doi.org/10.1038/nrclinonc.2014.224
Neeman E, Ben-Eliyahu S. Surgery and stress promote cancer metastasis: new outlooks on perioperative mediating mechanisms and immune involvement. Brain Behav Immun. 2013;30(Suppl.):S32-40. https://doi.org/10.1016/j.bbi.2012.03.006
O’Shaughnessy J. Extending survival with chemotherapy in metastatic breast cancer. Oncologist. 2005;10(Suppl. 3):20-9. https://doi.org/10.1634/theoncologist.10-90003-20
Weng M, Chen W, Hou W, Li L, Ding M, Miao C. The effect of neuraxial anesthesia on cancer recurrence and survival after cancer surgery: an updated meta-analysis. Oncotarget. 2016;7(12):15262-73. https://doi.org/10.18632/oncotarget.7683
Deegan CA, Murray D, Doran P, Moriarty DC, Sessler DI, Mascha E, et al. Anesthetic Technique and the Cytokine and Matrix Metalloproteinase Response to Primary Breast Cancer Surgery. Reg Anesth Pain Med. 2010;35(6):490-5. https://doi.org/10.1097/aap.0b013e3181ef4d05
Wu J, Buggy D, Fleischmann E, Parra-Sanchez I, Treschan T, Kurz A, et al. Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial. Can J Anaesth. 2015;62(3):241-51. https://doi.org/10.1007/s12630-014-0285-8
Li R, Xiao C, Liu H, Huang Y, Dilger JP, Lin J. Effects of local anesthetics on breast cancer cell viability and migration. BMC Cancer. 2018;18(1):666. https://doi.org/10.1186/s12885-018-4576-2
Ecimovic P, McHugh B, Murray D, Doran P, Buggy DJ. Effects of Sevoflurane on Breast Cancer Cell Function In Vitro. Anticancer Res. 2013;33(10):4255-60.
Melamed R, Bar-Yosef S, Shakhar G, Shakhar K, Ben-Eliyahu S. Suppression of Natural Killer Cell Activity and Promotion of Tumor Metastasis by Ketamine, Thiopental, and Halothane, but Not by Propofol: Mediating Mechanisms and Prophylactic Measures. Anesth Analg. 2003;97(5):1331-9. https://doi.org/10.1213/01.ane.0000082995.44040.07
Yuki K, Astrof NS, Bracken C, Sulpicio GS, Shimaoka M. Sevoflurane binds and allosterically blocks integrin lymphocyte function-associated antigen-1. Anesthesiology. 2010;113(3):600-9. https://doi.org/10.1097/aln.0b013e3181e89a77
Juneja R. Opioids and cancer recurrence. Curr Opin Support Palliat Care. 2014;8(2):91-101. https://doi.org/10.1097/spc.0000000000000056
Lin X, Wang YJ, Li Q, Hou YY, Hong MH, Cao YL, et al. Chronic high-dose morphine treatment promotes SH-SY5Y cell apoptosis via c-Jun N-terminal kinase-mediated activation of mitochondria-dependent pathway. FEBS J. 2009;276(7):2022-36. https://doi.org/10.1111/j.1742-4658.2009.06938.x
Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105(4):660-4. https://doi.org/10.1097/00000542-200610000-00008
Lee JH, Kang SH, Kim Y, Kim HA, Kim BS. Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: A retrospective study. Korean J Anesthesiol. 2016;69(2):126-32. https://doi.org/10.4097/kjae.2016.69.2.126
Koonce SL, Mclaughlin SA, Eck DL, Porter S, Bagaria S, Clendenen SR, et al. Breast cancer recurrence in patients receiving epidural and paravertebral anesthesia: a retrospective, case-control study. Middle East J Anaesthesiol. 2014;22(6):567-71.
Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. The Cochrane Collaboration; 2011.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. BMJ. 2015;350:g7647. https://doi.org/10.1136/bmj.g7647
National Library of Medicine (US). Clinical Trials [Internet]. Bethesda: National Library of Medicine [cited on Dec. 30, 2020]. Available from: https://clinicaltrials.gov
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343;d5928. https://doi.org/10.1136/bmj.d5928
Cho JS, Lee MH, Kim SI, Park S, Park HS, Oh E, et al. 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-
https://doi.org/10.7150/ijms.20064
Yan T, Zhang G-H, Cheng Y-Z, Wu L-X, Liu X-Y, Sun Y-L, et al. Effects of anesthetic technique and surgery on myeloid-derived suppressor cells and prognosis in women who underwent breast cancer surgery: a prospective study. Cancer Manag Res. 2019;11:5513-22. https://doi.org/10.2147/cmar.s183519
Finn DM, Ilfeld BM, Unkart JT, Madison SJ, Suresh PJ, Sandhu NPS, et al. Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation. J Anesth. 2017;31(3):374-9. https://dx.doi.org/10.1007%2Fs00540-017-2345-z
Karmakar MK, Samy W, Lee A, Li JW, Chan WC, Chen PP, et al. Survival Analysis of Patients with Breast Cancer Undergoing a Modified Radical Mastectomy With or Without a Thoracic Paravertebral Block: a 5-Year Follow-up of a Randomized Controlled Trial. Anticancer Res. 2017;37(10):5813-20. https://doi.org/10.21873/anticanres.12024
Sessler DI, Pei L, Huang Y, Fleischmann E, Marhofer P, Kurz A, et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet. 2019;394(10211):1807-15. https://doi.org/10.1016/S0140-6736(19)32313-X
Wigmore TJ, 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. https://doi.org/10.1097/aln.0000000000000936
Inada T, Kubo K, Shingu K. Possible link between cyclooxygenase-inhibiting and antitumor properties of propofol. J Anesth. 2011;25(4):569-75. https://doi.org/10.1007/s00540-011-1163-y
Farooqui M, Li Y, Rogers T, Poonawala T, Griffin RJ, Song CW, et al. COX-2 inhibitor celecoxib prevents chronic morphine-induced promotion of angiogenesis, tumour growth, metastasis and mortality, without compromising analgesia. Br J Cancer. 2007;97(11):1523-31. https://dx.doi.org/10.1038%2Fsj. bjc.6604057
Pirbudak Cocelli L, Ugur MG, Karadasli H. Comparison of effects of low-flow sevoflurane and desflurane anesthesia on neutrophil and T-cell populations. Curr Ther Res Clin Exp. 2012;73(1-2):41-51. https://doi.org/10.1016/j. curtheres.2012.02.005
Plein LM, Rittner HL. Opioids and the immune system -friend or foe. Br J Pharmacol. 2018;175(14):2717-25. https://doi.org/10.1111/bph.13750
Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010;105(2):106-15. https://doi.org/10.1093/bja/aeq164
Cronin AJ, Aucutt-Walter NM, Budinetz T, Bonafide CP, DiVittore NA, Gordin V, et al. Low-dose remifentanil infusion does not impair natural killer cell function in healthy volunteers. Br J Anaesth. 2003;91(6):805-9. https://doi.org/10.1093/bja/aeg273
Sacerdote P, Manfredi B, Mantegazza P, Panerai AE. Antinociceptive and immunosuppressive effects of opiate drugs: a structure-related activity study. Br J Pharmacol. 1997;121(4):834-40. https://doi.org/10.1038/sj.bjp.0701138
Houze de l’Aulnoit A, Rogoz B, Pincon C, Houze de l’Aulnoit D. Metastasis-free interval in breast cancer patients: Thirty-year trends and time dependency of prognostic factors. A retrospective analysis based on a single institution experience. Breast. 2018;37:80-8. https://doi.org/10.1016/j. breast.2017.10.008
Forget P, Vandenhende J, Berliere M, Machiels J-P, Nussbaum B, Legrand C, et al. Do intraoperative analgesics influence breast cancer recurrence after mastectomy? A retrospective analysis. Anesth Analg. 2010;110(6):1630-5. https://doi.org/10.1213/ane.0b013e3181d2ad07
Li A, Xin W, Ma C. Fentanyl inhibits the invasion and migration of colorectal cancer cells via inhibiting the negative regulation of Ets-1 on BANCR. Biochem Biophys Res Commun. 2015;465(3):594-600. https://doi.org/10.1016/j.bbrc.2015.08.068
Cronin-Fenton DP, Heide-Jørgensen U, Ahern TP, Lash TL, Christiansen PM, Ejlertsen B, et al. Opioids and breast cancer recurrence: A Danish population-based cohort study. Cancer. 2015;121(19):3507-14. https://doi.org/10.1002/cncr.29532
Yardeni IZ, Beilin B, Mayburd E, Alcalay Y, Bessler H. Relationship between fentanyl dosage and immune function in the postoperative period. J Opioid Manag. 2008;4(1):27-33. https://doi.org/10.5055/jom.2008.0005
Kairaluoma P, Mattson J, Heikkila P, Pere P, Leidenius M. Perioperative Paravertebral Regional Anaesthesia and Breast Cancer Recurrence. Anticancer Res. 2016;36(1):415-8.
Deegan CA, Murray D, Doran P, Ecimovic P, Moriarty DC, Buggy DJ. Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro. Br J Anaesth. 2009;103(5):685-90. https://doi.org/10.1093/bja/aep261
Karmakar MK, Samy W, Li JW, Lee A, Chan WC, Chen PP, et al. Thoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy. Reg Anesth Pain Med. 2014;39(4):289-98. https://doi.org/10.1097/aap.0000000000000113
Cata JP, Forget P. Paravertebral block with propofol anaesthesia does not improve survival compared with sevoflurane anaesthesia for breast cancer surgery: independent discussion of a randomised controlled trial. Br J Anaesth. 2020;124(1):19-24. https://doi.org/10.1016/j.bja.2019.09.039
Ishikawa M, Sakamoto A, Ma D. Recurrence of breast cancer after anaesthesia. Lancet. 2020;396(10248):375-6. https://doi.org/10.1016/S0140-6736(20)30488-8
Moris D, Kontos M. Recurrence of breast cancer after anaesthesia. Lancet. 2020;396(10248):376-7. https://doi.org/10.1016/S0140-6736(20)30489-X
Nielsen KC, Melton MS, Gebhard RE, Greengrass RA. Recurrence of breast cancer after anaesthesia. Lancet. 2020;396(10248):376. https://doi.org/10.1016/S0140-6736(20)30487-6
Nounou MI, ElAmrawy F, Ahmed N, Abdelraouf K, Goda S, Syed-Sha-Qhattal H. Breast Cancer: Conventional Diagnosis and Treatment Modalities and Recent Patents and Technologies. Breast Cancer (Auckl). 2015;9(Suppl. 2):17-34. https://doi.org/10.4137/bcbcr.s29420
Hennigs A, Riedel F, Marmé F, Sinn P, Lindel K, Gondos A, et al. Changes in chemotherapy usage and outcome of early breast cancer patients in the last decade. Breast Cancer Res Treat. 2016;160(3):491-9. https://doi.org/10.1007/s10549-016-4016-4
Forget P, Aguirre JA, Bencic I, Borgeat A, Cama A, Condron C, et al. How anesthetic, analgesic and other non-surgical techniques during cancer surgery might affect postoperative oncologic outcomes: A summary of current state of evidence. Cancers (Basel). 2019;11(5):592. https://doi.org/10.3390/cancers11050592
Buckley A, McQuaid S, Johnson P, Buggy D. Effect of anaesthetic technique on ER positive breast cancer cell apoptosis in the presence of CD56+ NK cells. Ir J Med Sci. 2013;182:S60. Available from: https://www.embase.com/search/results?subaction=viewrecord&id=L71326324&from=export
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Aline Tenório Dourado, Amanda Vasconcelos de Albuquerque, Dayse Figueiredo Ribeiro de Sena, José Lamartine de Andrade Aguiar
This work is licensed under a Creative Commons Attribution 4.0 International License.
