Abstract
BACKGROUND & AIMS: Globally breast-cancer is the commonest female malignancy (24.5%) with surgery being the mainstay of management.). However both anaesthesia as well as surgery can have implications on metastasis as well as recurrence. The present study was a prospective-study aimed to compare immune-inflammatory response of isoflurane and propofol in breast-cancer. METHODS: Peripheral blood-samples were collected [Pre (day before surgery), Intra (1 hour after incision), Post (48 hour postop)] to analyse immune-inflammatory markers. Total of 21 patients were randomised to receive either isoflurane (Iso; N,10) (in Isogroup, MAC 1) or propofol (Pro; N,11) (Pro group, with a target-controlled infusion of propofol, targeted at effect-site-concentration of 2-3 µg/mL) for maintenance of anaesthesia. All patients were induced with Injection thiopentone 3-5 mg/kg/intravenous titrated to loss of eyelash reflex and Injection fentanyl 2 mg/kg was used as analgesic. The trachea was intubated after muscle relaxation with Injection vecuronium 0.1mg/kg intravenous. All patients were reversed with neostigmine and glycopyrolate, Peripheral blood-samples were collected [Pre (day before surgery), Intra (1 hour after incision), Post (48 hour postop)] to analyse immune-inflammatory markers. RESULTS: Analysis was done using advanced-statistics Mixed-Design ANOVA and power-analysis by G*Power. It was found that Propofol significantly upregulated both frequency (CD3-CD56+) and degranulation activity (CD3-CD56+CD107a+) of natural killer (NK)-cells than isoflurane(effect-size 0.164). Isoflurane significantly(p=0.006) suppressed helper-T-cells (Th, CD3+CD4+), aggravated CD4:CD8 greater than propofol. There was no significant difference on B-cells (CD3-CD19+), cytotoxic- cells (Tc, CD3+ CD8+), pro-inflammatory-mediators(IL-8, IFN, IL-6, TNFï•¡, IL-12, MMP-9) and anti-inflammatory-cytokines(IL-10). However, intra-operative and post-operative rise in IL-15 was significantly inhibited by propofol but not with isoflurane. CONCLUSION: The present prospective-randomised-double-blinded-pilot study elucidates the superiority of propofol over isoflurane against NK cells and Th-cells anergy and sustained release of IL-15 in breast cancer surgery in terms of tumour recurrence and disease free survival.