BREAST CANCER: Top 5 latest articles

       BREAST  CANCER:

 TOP 5 LATEST ARTICLES AND UPDATES IN THE FIELD OF   ONCO - ANESTHESIA

INTRODUCTION: 

As I mentioned in my previous articles Anesthesia can impact long term survival in cancer patients. The surgical inflammatory response can be attenuated or increased by the choice of anesthetics we use. So, having good expertise in this field can help in improving the quality as well as survival of patients. In this edition let's look into recent advances and upliftments in management of patients diagnosed with breast cancer.

The FIRST ARTICLE:

Article published by jin su cho enlightens us about the perioperative anesthesia and analgesia and their effect on Natural Killer (NK) cell activity. Their study compared fentanyl and sevoflurane anesthesia with propofol and ketorolac anesthesia in breast cancer patients undergoing Breast surgeries. They concluded intraoperative propofol with postoperative ketorolac analgesia  had preserved NK cell activity and tumor suppression effect. 

In terms of postoperative inflammatory response and short term recurrence both groups did not show any significant difference. Pain and opioid analgesics are shown to decrease the NK cell activity. Fentanyl and Morphine suppress NK cell activity whereas Ketorolac protects NK cell activity. Neutrophil lymphocyte ratio is said to be the prognostic indicator of breast cancer. Sevoflurane, Fentanyl decreases lymphocyte count, whereas propofol has protective effect.

The SECOND ARTICLE:

The second article by Daniel Sessler signifies the recurrence of breast cancer after regional or General anesthesia. They compared with group 1 receiving paravertebral block and other other groups receiving volatile anesthesia. The frequency and duration of incisional pain was unaffected by anesthetic technique. Even the breast recurrence rate did not affect either group of population suggesting anesthetists can follow either regional or volatile anesthetics depending on their convenience.

The THIRD ARTICLE:

Rajendra Badwe published an article on peritumoral infiltration with local anesthetic before breast surgery and they studied its effect on survival in early breast cancer. Local anesthetic block voltage gated Na- channels and prevented activation of prometastatic pathways. Women assigned to local anesthetic groups received 0.5% lignocaine infiltration 7-8 minutes prior to surgery. 

This study summarizes that women with peritumoral lignocaine infiltration had a long disease free state and survival rate compared to non local anesthetic infiltration groups. The postsurgery treatment compliance remained same in both groups in regards to radiotherapy , HER 2 therapy and endocrine therapy. 

The FOURTH ARTICLE:

James Khan article on intraoperative lignocaine infusion for persistent pain in patients undergoing breast surgeries. Post mastectomy pain syndrome is a major postoperative complaint in breast surgery patients. Intravenous lidocaine have been used in acute pain, cancer pain, diabetic neuropathy and complex regional pain syndrome. 

Their study concluded lidocaine being inexpensive, easily available can significantly reduce pain and pot mastectomy pain syndrome. This also helps in reduction of chronic pain management, decreases opioid use and improve the quality of life in breast cancer patients undergoing surgery.

The FIFTH ARTICLE:

Su liu article is quite interesting on application of enhanced recovery after surgery(ERAS) in patients undergoing breast surgery. The concept of accelerated prehabilitation has been widely used in breast surgeries. This can reduce postoperative complications, surgical stress can improve the faster discharge time.

Preoperative stages should focus on education, hospital visits and evaluation, cessation of smoking and alcohol use, prevention of venous thrombosis, fasting, skin preparation, prophylactic use of antibiotics, and blood glucose control. The intraoperative stage should consider the management of hypothermia, blood glucose control to prevent venous thrombosis, and perioperative fluid therapy. During the postoperative stage, the nursing plan of care should focus on pulmonary rehabilitation exercise, nausea and vomiting prevention, and treatment, pain management, early eating, skin flap monitoring, drainage tube management, incision care, early ambulation, discharge standards and follow-up, and health education.

Application of accelerated rehabilitation surgery during the perioperative phase of patients undergoing modified radical mastectomy was conducive to reducing opioid consumption, hospital length of stay, and hospitalization costs, while accelerating functional recovery in the limbs following surgery, and improving quality of life.

These are best 5 recent papers and effective management strategies in breast cancer patients undergoing breast surgeries.