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

Abstract

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.

Effects of epidural anesthesia on the prognosis of ovarian cancer—a systematic review and meta-analysis

“…The same result was found in the subgroup analysis of EIP. Our results from the comprehensive meta-analysis coincided with most, even not all, results from recently reported studies [ 5 , 19 ]. According to the COX regression analysis of included studies, the long-term prognosis of ovarian cancer patients after surgery was also related to tumor stage, whether the tumor reduction operation was complete, as showed up the outcomes part.…”

Regional anesthesia might reduce recurrence and metastasis rates in adult patients with cancers after surgery: a meta-analysis

“…Then, 5233 kinds of literature were excluded after reviewing the title or abstract. After retrieving 44 full-length articles, ultimately, 27 studies [2,3,5,[11][12][13][14][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] were eligible for data extraction and meta-analysis. Besides, five studies [4,[43][44][45][46] were in our meta-analysis by manual search.…”

Anaesthesia and cancer recurrence: the influence of perioperative anaesthetic technique on cancer recurrence after surgery

“…It was originally hypothesized that use of regional anaesthesia-analgesia reduced the risk of cancer recurrence [1,2], perhaps by reducing opioid requirements or preserving antitumour effects of the innate immune system through suppression of the stress response [3]. Although retrospective studies continue to be published reporting the association between neuraxial or regional anaesthesia and apparently beneficial cancer outcomes [19,20], level I evidence refutes this hypothesis. The first major RCT examining anaesthesia and cancer recurrence compared a combined paravertebral regional anaesthesia-propofol technique to a volatile-opioid technique in more than 2100 women undergoing breast cancer surgery and detected no difference in recurrence or disease-free survival [18].…”