Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses

Abstract

Background: Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia. Materials and Methods: Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3 + , CD19 + , CD4 + , CD8 + , CD16 + CD56 + and CD4 + /CD8 + ratio was examined at baseline and on postoperative days 1, 2 and 3. Results: Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04). Conclusion: In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia. Lymphocytes are fundamental types of white blood cells. Cells of the lymphatic system play a crucial role in the immune system due to their regulatory function through regulatory cytokines and due to cytotoxic activity against tumors and infections (1, 2). As underlined in the literature, surgical stress and general anesthesia may reduce the numbers of circulating lymphocytes (1-6). It is a widely held view that impairment of immune function can predispose to infectious complications such as surgical site infections (SSI) (5-8). Moreover, reduced cytotoxic activity of peripheralblood lymphocytes can increase the probability of tumor progression and metastasis (4, 5, 9-13). According to several studies, use of a minimally invasive approach in thoracic surgery (1, 14, 15) and abdominal surgery (16-18) demonstrated that immune function may be better preserved. However, there is lack of high-level evidence about the protective role of minimally invasive techniques in early lymphocyte response and it is conceivable that, regardless of the surgical approach, any 1879 This article is freely accessible online.

The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey

“…Therefore, several guidelines have been published in order reduce the detrimental effect of COVID-19 outbreak (2,7,8,(31)(32)(33). Triage of urgent clinical cases, awake and fast track surgery could increase the number of treated patients, reducing hospitalizations as well as the risk of cross-infection during the COVID-19 era (8,(34)(35)(36)(37)(38). Breast oncological treatment was only partially impaired by the COVID-19 outbreak and breast specialists try to provide the best cancer treatment for a higher number of patients (2,7,8,35,39).…”

“…Triage of urgent clinical cases, awake and fast track surgery could increase the number of treated patients, reducing hospitalizations as well as the risk of cross-infection during the COVID-19 era (8,(34)(35)(36)(37)(38). Breast oncological treatment was only partially impaired by the COVID-19 outbreak and breast specialists try to provide the best cancer treatment for a higher number of patients (2,7,8,35,39). Hence, breast cancer specialists could provide a good model for understanding how the COVID-19 outbreak could influence health well-being among the low risk HCWs population.…”

Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario

“…Furthermore, advanced stages could require adjuvant and neoadjuvant treatments that could have been avoided. All this would lead to a deterioration in patients' quality of life and an increase in healthcare costs (35)(36)(37).…”

“…In our opinion, the National Health care system should take any measures in order to prevent the COVID-19 detrimental effect on BC (3,4). BC centers changed their clinical practice to reduce hospitalization (32,(40)(41)(42)(43) and immunological impact of surgical treatment (36,44). During the COVID pandemic several facilities implemented or created tele-health programs for breast patients (20).…”

Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Breast Cancer: A Propensity Score-Matching Study

“…Thirdly, the fact that we have collected some survival information over the phone may have introduced information bias. Finally, different surgical procedures may affect inflammatory indicators and inflammatory indicators may also change before and after surgery (28)(29)(30). In view of the limitation of existing data (only 185 patients underwent breast-conserving surgery), we will further study the influence of different surgical procedures and changes in preoperative and postoperative inflammatory indicators on the prognosis in subsequent studies.…”