Immunomodulatory Effects of General Anesthesia in Patients with Breast Cancer - An Observational Study

Breast cancer is a prevalent malignancy in women. General anesthesia (GA) is commonly employed during breast cancer surgery. However, GA is not immunologically inert. Cell-mediated immunity plays a role in antitumor immunity. The primary objective of this study was to compare levels of tumor necrosis factor alpha (TNF α), interleukin (IL) 1, IL6, IL 10, interferon gamma (IFN-γ), leukocytes, lymphocytes, neutrophils, monocytes, eosinophils, and basophils before and after GA for breast cancer surgeries.

This prospective observational study was conducted on thirty patients undergoing breast cancer surgery under GA. The anesthesia was achieved using IV glycopyrrolate, midazolam, fentanyl, propofol, and laryngeal mask airway. Anesthesia was maintained using a mixture of oxygen, nitrous oxide, and isoflurane. At the end of the procedure, IV paracetamol 1 g and ondansetron 4 mg were administered. Blood samples for immunemodulators were collected before and 2 h after the induction of anaesthesia.

The total leukocyte count showed a nonsignificant increase with a P = 0.148. Lymphocyte count significantly decreased from 30.59 ± 9.19 to 25.69 ± 8.74 ( P = 0.003). Neutrophil count increased significantly from 61.22 ± 8.97 to 66.15 ± 9.79 ( P = 0.014). Monocyte, eosinophil, and basophil counts did not show any significant difference. TNF-α levels increased significantly from 49.54 ± 16.04 to 54.95 ± 19.03 ( P = 0.037). IL-1, IL-2, IL-6, IL-10, and IFN-γ did not show any statistically significant difference. To conclude, GA in patients undergoing breast cancer surgery induces measurable immunomodulatory effects, characterized by a significant decrease in lymphocyte and an increase in neutrophil counts with stable total leukocyte counts. The significant increase in TNF-α with nonsignificant changes in other inflammatory markers, such as IL-1, IL-2, IL-6, IL-10, and IFN-γ, was also noted. These findings suggest that anesthesia may influence the immune response in this vulnerable patient population, and perioperative immune perturbations could modulate short-term metastatic risk, though long-term studies are needed to confirm clinical relevance.