Eden Caroline, Esses Gary, Katz Daniel, DeMaria Samuel
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY, USA.
Surg Oncol. 2018 Jun;27(2):266-274. doi: 10.1016/j.suronc.2018.05.001. Epub 2018 May 5.
This narrative review will summarize our current understanding of the effects of perioperative interventions on patients undergoing surgical removal of breast malignancies. It will focus on how different anesthetic agents and perioperative interventions might affect both breast cancer behavior and/or tumor recurrence as well as postoperative recovery. The main objective of this study will be to describe the evidence and critically analyze preclinical and clinical studies on the use of intravenous versus inhaled anesthetic agents, opioids, regional anesthetics, and anesthetic adjuncts in patients undergoing breast cancer resection. We will look both at the evidence regarding cancer-related outcomes and postoperative recovery. A search of PubMed, from inception to May 2017 was performed using Mesh terms Breast Neoplasms [Mesh] OR cancer AND breast AND Anesthesia [Mesh]; "Anesthetics"[Mesh] AND "Breast Neoplasms/surgery"[Mesh]. Although no optimal anesthetic combination has been identified for patients undergoing breast cancer resection, it should be noted that based on the available evidence, an ideal anesthetic in this patient population would involve a combination of TIVA (propofol), regional anesthesia (paravertebral block)), non opioid sedatives (clonidine or dexmedetomidine), and COX-2 inhibition (ketorolac). Based on the current evidence, this combination of anesthetic and analgesic agents has the best chance of improving cancer-related outcomes and postoperative recovery.
本叙述性综述将总结我们目前对围手术期干预措施对接受乳腺恶性肿瘤手术切除患者影响的理解。它将聚焦于不同的麻醉药物和围手术期干预措施如何可能影响乳腺癌的行为和/或肿瘤复发以及术后恢复。本研究的主要目的是描述相关证据，并批判性地分析关于在接受乳腺癌切除术的患者中使用静脉麻醉药与吸入麻醉药、阿片类药物、区域麻醉药和麻醉辅助药物的临床前和临床研究。我们将审视有关癌症相关结局和术后恢复的证据。使用医学主题词“乳腺肿瘤[医学主题词]”或“癌症”以及“乳腺”和“麻醉[医学主题词]”；“麻醉药[医学主题词]”和“乳腺肿瘤/外科学[医学主题词]”对PubMed数据库从建库至2017年5月进行了检索。尽管尚未确定针对接受乳腺癌切除术患者的最佳麻醉组合，但应当指出，基于现有证据，该患者群体的理想麻醉应包括全凭静脉麻醉（丙泊酚）、区域麻醉（椎旁阻滞）、非阿片类镇静剂（可乐定或右美托咪定）以及环氧化酶-2抑制（酮咯酸）。基于目前的证据，这种麻醉和镇痛药物的组合最有可能改善癌症相关结局和术后恢复。
