The effect of regional vs. general anesthesia on the immune response in breast cancer surgery: anarrative review of the literature
| Autor: | Vrbanović Mijatović, Vilena, Gatin, Lucija, Tonković, Dinko, Bandić Pavlović, Daniela, Smuđ Orehovec, Sanda, Miklić Bublić, Martina, Mijatović, Davor |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Operacija karcinoma dojke
opća anestezija regionalna anestezija imunosupresija imunološki odgovor breast cancer surgery general anesthesia immune response immunosuppression regional anesthesia Breast Cancer Surgery General Anesthesia Regional Anesthesia Immunosuppression Immune Response General Medicine |
| Zdroj: | Acta clinica Croatica Volume 61. Issue Supplement 2 |
| ISSN: | 0353-9466 1333-9451 |
| Popis: | For breast cancer patients, surgery remains the cornerstone in treatment. Perioperative and postoperative period is associated with impaired immune function that can have profound implications for cancer patients in terms of tumor recurrence and metastases. The three main factors include surgery and related neuroendocrine stress response, anesthetic drugs, including opioid analgesics and postoperative pain. The most investigated immune cells are natural killer (NK) cells that are affected by both anesthesia and surgery. It has been demonstrated that ketamine, thiopental, volatile anesthetics, fentanyl and morphine, but not propofol, remifentanil or tramadol reduce the number of circulating NK cells and depress their toxicity. The level of NK cells’ cytotoxicity is inversely proportional to the stage and spread of cancer. Regional anesthesia and its potential beneficial effects on the perioperative immune response and long-term outcome after surgery has been investigated as an alternative to general anesthesia in patients undergoing breast cancer surgery. In this paper, we present a review of literature aimed to assess the impact of regional anesthesia techniques on the immune response in patients undergoing breast cancer surgery and how it compares to general anesthesia. Za pacijente s rakom dojke operacija je neizostavni dio terapijskog postupka. Predoperativno i postoperativno razdoblje je povezano s oslabljenom imunološkom funkcijom koja može imati značajne posljedice za bolesnike s karcinomom u smislu recidiva tumora i metastaza. Tri su glavna čimbenika odgovorna za takve promjene i uključuju operaciju i s njom povezan neuroendokrini stresni odgovor, anestetike uključujući opioidne analgetike i postoperativnu bol. Najčešće istraživane imunološke stanice su prirodne stanice ubojice (NK) na koje utječu i anesteziološki i kirurški postupak. Pokazano je da ketamin, tiopental, hlapljivi anestetici, fentanilimorfin, ali ne i propofol, remifentanil i tramadol, smanjuju broj cirkulirajućih NK stanica i njihovu citotoksičnost. Razina citotoksičnosti NK stanica obrnuto je proporcionalna stadiju i proširenosti karcinoma. Regionalna anestezija i njezin mogući povoljan učinak na predoperativni imunološki odgovor i dugoročni ishod nakon operacije istraživani su kao alternativa općoj anesteziji u bolesnica koje su podvrgnute operaciji karcinoma dojke. Cilj ovog pregleda literature je procjena utjecaja regionalne anestezije na imunološki odgovor u pacijentica podvrgnutih operaciji karcinoma dojke te njezina usporedba s općom anestezijom. |
| Databáze: | OpenAIRE |
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