Effects of propofol/remifentanil-based total intravenous anesthesia versus sevoflurane-based inhalational anesthesia on the release of VEGF-C and TGF-β and prognosis after breast cancer surgery: a prospective, randomized and controlled study

• Published in: BMC anesthesiology Vol. 18; no. 1; p. 131
• Main Authors: Yan, Tao, Zhang, Guo-Hua, Wang, Bao-Na, Sun, Li, Zheng, Hui
• Format: Journal Article
• Language: English
• Published: England BioMed Central 22.09.2018; BMC
• Subjects: Adult; Anesthesia; Anesthesia, Inhalation - methods; Anesthesia, Inhalation - trends; Anesthesia, Intravenous - methods; Anesthesia, Intravenous - trends; Angiogenesis; Apoptosis; Biomarkers - blood; Breast cancer; Breast Neoplasms - blood; Breast Neoplasms - surgery; Breast surgery; Cancer surgery; Drug Therapy, Combination; Female; Fentanyl; Follow-Up Studies; Humans; Intravenous administration; Mastectomy; Medical prognosis; Metastases; Metastasis; Middle Aged; Narcotics; Nonsteroidal anti-inflammatory drugs; Opioids; Pain; Prognosis; Propofol; Propofol - administration & dosage; Prospective Studies; Randomization; Remifentanil; Remifentanil - administration & dosage; Sevoflurane; Sevoflurane - administration & dosage; Stress response; Surgery; Total intravenous anesthesia; Transforming Growth Factor beta - blood; Transforming growth factor-b; Treatment Outcome; Tumors; Vascular endothelial growth factor; Vascular Endothelial Growth Factor C - blood; Sevoflurane; Angiogenesis; Breast cancer; Propofol; Total intravenous anesthesia
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-018-0588-3

Vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) have been involved in tumor growth and metastasis. Sevoflurane may promote angiogenesis, whereas propofol can present an anti-angiogenic effect. In this study, we compared the effects of propofol/remifentanil-based total intravenous anesthesia (TIVA) and sevoflurane-based inhalational anesthesia on the release of VEGF-C and TGF-β, as well as recurrence- free survival (RFS) rates in the patients undergoing breast cancer surgery. Eighty female patients undergoing breast cancer resection were enrolled and randomized to receive either sevoflurane-based inhalational anesthesia (SEV group) or propofol/remifentanil-based TIVA (TIVA group). The serum concentrations of VEGF-C and TGF-β before and 24 h after surgery were measured and RFS rates over a two-year follow-up were analyzed in both groups. The postoperative pain scores assessed using a visual analogue scale (VAS) and the use of perioperative opioids were also evaluated. Although VAS scores at 2 h and 24 h after surgery were comparable between the two groups, there were more patients receiving postoperative fentanyl in the TIVA group (16[40%]) compared with the SEV group (6[15%], p = 0.023). VEGF-C serum concentrations increased after surgery from 105 (87-193) pg/ml to174 (111-281) pg/ml in the SEV group (P = 0.009), but remained almost unchanged in the TIVA group with 134 (80-205) pg/ml vs.140(92-250) pg/ml(P = 0.402). The preoperative to postoperative change for VEGF-C of the SEV group (50 pg/ml) was significantly higher than that of the TIVA group (12 pg/ml) with a difference of 46 (- 11-113) pg/ml (P = 0.008). There were also no significant differences in the preoperative and postoperative TGF-β concentrations between the two groups. The two-year RFS rates were 78% and 95% in the SEV and TIVA groups (P = 0.221), respectively. In comparison with sevoflurane-based inhalational anesthesia, propofol/remifentanil -based total intravenous anesthesia can effectively inhibit the release of VEGF-C induced by breast surgery, but didn't seem to be beneficial in the short-term recurrence rate of breast cancer. Chictr.org.cn ChiCTR1800017910 . Retrospectively Registered (Date of registration: August 20, 2018).