Comparison of Outcomes After Breast Cancer Surgery Between Inhalational and Propofol-Based Intravenous Anaesthesia: A Systematic Review and Meta-Analysis

Abstract

Background: General anaesthesia is the commonly provided for breast cancer surgery, but the effects of inhalational anaesthesia and propofol-based intravenous anaesthesia on shortand long-term outcomes after breast cancer surgery are not clear. In this study, we conduct a meta-analysis of randomized controlled trials (RCTs) to explore the superior anaesthetic for breast cancer surgery patients. Methods: We searched the Embase, Medline, Cochrane Library, Web of Science, CNKI, and Wanfang databases (up to January, 2021) for RCTs in which inhalational anaesthesia and propofol-based intravenous anaesthesia were compared and short-and long-term outcomes were assessed in breast cancer surgical patients. The meta-analysis was performed by Stata 12.0. Results: Twenty RCTs with a total of 2201 patients were included. Compared with inhalational anaesthesia, propofol-based intravenous anaesthesia was associated with more postoperative rescue analgesia (I 2 =0%, RR: 1.18, 95% CI: 1.07-1.30, P=0.001) but a lower incidence of postoperative nausea and vomiting (PONV) (I 2 =25.5%, RR: 0.71, 95% CI: 0.62-0.81, P<0.001) and postoperative rescue antiemetics (I 2 =0%, RR: 0.69, 95% CI: 0.58-0.82, P<0.001). Propofol-based intravenous anaesthesia preserved nature killer cell cytotoxicity (I 2 =86.2%, SMD: 0.76, 95% CI: 0.13-1.39, P=0.018), decreased IL-6 level (I 2 =98.0%, SMD: −3.09, 95% CI: −5.70-−0.48, P=0.021) and neutrophil-to-lymphocyte ratio (I 2 =0%, SMD: −0.28, 95% CI: −0.53-−0.03, P=0.030), and increased 2-year recurrence-free survival rate (I 2 =0%, RR: 1.10, 95% CI: 1.00-1.20, P=0.043) but did not affect recurrence or the overall survival rate (P>0.05). Conclusion:Propofol-based intravenous anaesthesia increases postoperative rescue analgesia but reduces PONV compared with inhalational anaesthesia in breast cancer surgery. The benefit of propofol over inhalational anaesthetics in the preservation of anti-cancer immunity is obvious, but it is difficult to conclude that propofol can exert long-term benefits due to the small sample size.

Mechanisms of Cancer Inhibition by Local Anesthetics

“…Levobupivacaine and ropivacaine reduced tumor cell invasion and migration by reducing RhoA protein levels (Castelli et al, 2020). Some studies showed that sodium channel blockade contributed to the anticancer activity of LAs (Fraser et al, 2014), but these studies also demonstrated that bupivacaine inhibited the migration of gastric cancer cells via the sodiumindependent channel blocker RhoA and NET1 inhibition (Dan et al, 2018;Zheng et al, 2020;Pang et al, 2021). These results suggest that LAs are associated with the RhoA and NET1 pathways in addition to sodium channel blockade.…”

“…Rho and RAC GTP enzymes regulate all types of cell migration ( Zheng et al, 2020 ), and one of the activators of the Ras homolog gene family member A (RhoA) pathway is neuroepithelial cell gene 1 (NET1) ( Pang et al, 2021 ). Rho-associated protein kinase (Rock) is a downstream effector of the RhoA pathway.…”

“…Bupivacaine decreased the phosphorylation of MYPT1 and MLC1, which reduced the migration of gastric cancer cells. Research also suggests that bupivacaine inhibits the migration of cancer cells by stimulating NET1 ( Pang et al, 2021 ). NET1 is significantly up-regulated in gastric and breast cancers, which suggests that bupivacaine is involved in tumor migration via this pathway to inhibit tumor migration.…”

Antitumorigenic Effect of Tramadol and Synergistic Effect With Doxorubicin in Human Breast Cancer Cells

“…( 2 ) The mechanisms through which anesthetic-analgesic techniques influence breast cancer outcomes have increasingly garnered attention although the results of research have been inconsistent. ( 3 – 11 )…”

“…(2) The mechanisms through which anesthetic-analgesic techniques influence breast cancer outcomes have increasingly garnered attention although the results of research have been inconsistent. (3)(4)(5)(6)(7)(8)(9)(10)(11) Tramadol is a centrally acting analgesic that is widely accepted in the treatment of moderate postoperative pain. ( 12) Piñero and colleagues (13) reported that b-adrenoceptor agonists and a 2adrenoceptor antagonists can effectively suppress breast cancer cell proliferation and tumor growth via the inhibition of extracellular signal-regulated kinase 1/2 (ERK 1/2) phosphorylation in an animal model.…”