ИСТИНА

Background and Goal of Study: Recent evidence suggests that inhalation anesthesia (IA) is associated with higher cancer mortality than total intravenous anesthesia (TIVA), possibly due to a modula- tion of the immune response. The aim of this study was to determine the impact of anesthesia techniques on selected parameters of pa- tient immunity considering the evidence of relationship between the anesthesia methods and immune status and, consequently, the risk of breast cancer recurrence. Materials and Methods: We performed a meta-analysis of clinical studies published in PubMed, Google Scholar, and Cochrane data- bases, aimed at assessing the impact of anesthesia on the postop- erative immune status and overall survival in patients undergoing breast cancer (BC) surgery. 6 randomized and 12 retrospective co- hort studies were included (a total of 637 patients with immune sta- tus assessment (50.2% in the TIVA group) and 26469 patients with data on survival (39,6% TIVA),). Data on leukocy te counts, matrix metalloproteinases (MMP) 9 and 3, interleukins (IL) 6 and 10 levels, neutrophil-lymphocy te ratio (NLR) values, 3- and 5- year overall sur- vival (OS) data were retrieved. Data were analyzed using the Rev- Man v.5.3 tool (Nordic Cochrane Center, Cochrane Collaboration). RoB-2 tool was chosen to assess the risk of bias. Results and Discussion: Patients af ter breast cancer surgery who underwent TIVA had significantly lower white blood cell counts (stan- dardized mean dif ference (SMD)=–0.32; 95% CI: –0.58 to –0.06; I2=58%, P=0.020) and MMP-9 (SMD=–0.35; 95% CI: –0.67 to –0.03; P=0.030; I2=0%) in the postoperative period compared with patients receiving IA. No significant dif ferences in the levels of MMP- 3, IL-6, IL-10, and NLI values were found between the two groups. A meta-analysis of 9 retrospective cohort studies and 1 MRCT showed a detrimental ef fect of IA on 3-year OS in surgical oncology (Haz- ard Ratio (HR): 1.73 (1.36; 1.96)I2 = 64.01, overall ef fect analysis P<0.017). Analysis of 5-year OS failed to spot any dif ferences (P = 0.441), although it did not remove any doubts about the possible negative ef fect of the use of IA in surgical oncology. Conclusion(s): The patients who underwent breast cancer surgery under TIVA had lower blood leukocy te counts and levels of MMP-9, compared with those operated under IA. However, data from meta analysis of mostly retrospective cohort trials not to allow make an unambiguous conclusion about the advantages of TIVA in cancer surgery. https://www.esaic.org/uploads/2023/06/ea23_abstract_book.pdf