Araştırma Makalesi
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The Effect of Surgical Treatment Option on Inflammatory Response in Breast Cancers

Yıl 2023, , 253 - 262, 30.06.2023
https://doi.org/10.18663/tjcl.1310277

Öz

Aim:The aim of the study was to assess effect of different breast surgery techniques on the inflammatory response.
Material and Methods:The study executed between February 2013 and April 2013 in the General Surgery Clinic.The 42 patients aged between 18-70 years, who were diagnosed with breast cancer by tru-cut or incisional biopsy, were evaluated as stage I and II breast cancer according to AJCC criteria and underwent surgical treatment.In this prospectively study, descriptive statistics are given as mean±standard deviation, percentage and frequency.In comparison of groups, Kruskal-wallis test was used in comparison of three groups and Mann-Whitney-U test was used in comparison of two groups.Wilcoxon test was used for in-group comparison. The chi-square test was used to compare the count values between groups.The p<0.05 value at the 95% confidence interval was considered statistically significant.In correlation;Pearson correlation and Spearman correlation test were used.

Results:The total number of cases was 42. The mean age of the patients included in the study was 52.54±12.7 years old.Especially in terms of comparison of the preoperative and postoperative inflamatuvar markers;Postoperative IL-6 values were significantly higher than the preoperative IL-6 values in all three groups(p=0.001), postoperative white blood cell count too was found to be significantly higher in all three groups (p=0.003, p=0.001, p=0.001).Additionally, CRP levels were found to increase significantly in all three groups after surgery compared to preoperatively . While there was no difference between the groups in terms of preoperative CRP levels, CRP levels were found to be higher in the group that underwent lumpectomy and axillary dissection in the postoperative period compared to the other groups (p=0.004).
Conclusion:In the surgical methods to be chosen in breast cancer, methods that can keep the inflammatory reactions to a minimum by considering the severity of the trauma and fully meet the oncological principles for the patient should be kept in mind first.

Amaç: Bu çalışmanın amacı, farklı meme cerrahisi tekniklerinin inflamatuar yanıt üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Çalışma Şubat 2013-Nisan 2013 tarihleri arasında Genel Cerrahi Kliniği'nde gerçekleştirildi.tru-cut veya insizyonel biyopsi ile meme kanseri tanısı konulan 18-70 yaş arası 42 hasta AJCC kriterlerine göre evre I ve II meme kanseri olarak değerlendirilerek cerrahi tedavi uygulandı. Bu prospektif çalışmada, tanımlayıcı istatistikler ortalama±standart sapma, yüzde ve frekans olarak verilmiştir.Grupların karşılaştırılmasında üç grubun karşılaştırılmasında Kruskal-wallis testi, iki grubun karşılaştırılmasında Mann-Whitney-U testi kullanıldı. Grup içi karşılaştırmada Wilcoxon testi kullanıldı. Gruplar arasındaki sayım değerlerinin karşılaştırılmasında ki-kare testi kullanıldı. %95 güven aralığındaki p<0,05 değeri istatistiksel olarak anlamlı kabul edildi. Korelasyonda; Pearson korelasyonu ve Spearman korelasyon testi kullanıldı.
Bulgular: Toplam olgu sayısı 42 idi. Çalışmaya alınan hastaların yaş ortalaması 52,54±12,7 idi.
Özellikle preoperatif ve postoperatif inflamatuvar belirteçlerinin karşılaştırılması açısından; Postoperatif IL-6 değerleri her üç grupta da preoperatif IL-6 değerlerinden anlamlı olarak yüksek bulundu(p=0,001), postoperatif lökosit sayısı da her üç grupta da anlamlı olarak yüksek bulundu (p=0,003, p=0,001, p =0.001).Ayrıca ameliyattan sonra her üç grupta da ameliyat öncesine göre CRP düzeylerinin anlamlı olarak arttığı bulundu. Preoperatif CRP düzeyleri açısından gruplar arasında fark bulunmazken, postoperatif dönemde lumpektomi ve aksiller diseksiyon uygulanan grupta CRP düzeyleri diğer gruplara göre daha yüksek bulundu(p=0,004).
Sonuç: Meme kanserinde seçilecek cerrahi yöntemlerde öncelikle travmanın şiddeti göz önünde bulundurularak inflamatuar reaksiyonları minimumda tutabilen ve hasta için onkolojik prensipleri tam olarak karşılayan yöntemler akılda tutulmalıdır.

Destekleyen Kurum

Yoktur

Kaynakça

  • 1. Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy. Surg Endosc. 2003;17(2):342-50.
  • 2. Vlastos G., Verkooijen HM. Minimally invasive approaches for diagnosis and treatment of erly-stage breast cancer. The Oncologist 2007;12:1-10.
  • 3. Morrow M. Minimally invasive surgery for breast cancer. BMJ. 2009 19;338:845-846.
  • 4. Ito K, Kanai T, Gomi K, Watanabe T, Ito T Komatsu A et al. Endoscopic-assisted skin-sparing mastectomy combined with sentinel node biopsy. Aust NZJ Surg 2008;78:894-898
  • 5. Yamashita K, Shimizu K. Transaxillary retromammary route approach of video-assisted breast surgery enables the iner-side breast cancer to be resected for breast conserving surgery. Am J Surg 2008;196:578-581
  • 6. Ben-Eliyahu S. The price of anticancer intervention. Does surgery promote metastasis? Lancet Oncol. 2002;3(9):578-579.
  • 7. Goldfarb Y, Ben-Eliyahu S. Surgery as a risk factor for breast cancer recurrence and metastasis: mediating mechanisms and clinical prophylactic approaches. Breast Dis. 2006-2007;26:99-114.
  • 8. Vallejo R, Hord ED, Barna SA, Santiago-Palma J, Ahmed S. Prioperative immunosupression in cancer patients. J Environ Pathol Toxicol Oncol. 2003;22:139-146
  • 9. Brand JM, Kirchner H, Poppe C, Schmucker P. The effects of general anesthesia on human peripheral immune cell distribution and cytokine production. Clin Immunol Immunopathol. 1997 May;83:190-194.
  • 10. Page GG. Surgery-induced immunosupression and postoperative pain management. AACN Clin Issues 2005;16:302- 309; quiz 416-8.
  • 11. Yamauchi H, Kobayashi E, Yoshida T, Kiyozaki H, Hozumi Y, Kohiyama R, Suminaga Y, Sakurabayashi I, Fujimura A, Miyata M. Changes in immune-endocrine response after surgery. Cytokine. 1998;10(7):549-554.
  • 12. Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thörne A. Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999;43:146-152.
  • 13. Schietroma M, Carlei F, Cappelli S, Pescosolido A, Lygidakis NJ, Amicucci G Effects of cholecystectomy (laparoscopic versus open) on PMN-elastase. Hepatogastroenterology. 2007;54:342-345.
  • 14. Sietses C, Beelen RH, Meijer S, Cuesta MA. Immunological consequences of laparoscopic surgery, speculations on the cause and clinical implications. Langenbecks Arch Surg. 1999;384:250-258.
  • 15. Boomsma MF, Garssen B, Slot E, Berbee M, Berkhof J, Meezenbroek Ede J, Slieker W, Visser A, Meijer S, Beelen RH. Breast cancer surgery-induced immunomodulation. J Surg Oncol. 2010 Nov 1;102:640-648.
  • 16. McCoy JL, Rucker R, Petros JA. Cell-mediated immunity to tumor- associated antigens is a better predictor of survival in early stage breast cancer than stage, grade or lymph node status. Breast Cancer Res Treat 2000;60:227-234.
  • 17. Tschantz P, T.Y., Risk factors in elderly surgical patients: a prospective study. Swiss Surg., 1995. 3: p. 140-7.
  • 18. Schlos AMWJ, B.W., Staal-van den Brekel AJ, Dentener MA, Wouters EF. , Evidence for a relation between metabolic derangements and increased levels of imflammatory mediators in a group of patients with chronic obstructive pulmonary disease. Thorax, 1996. 51: p. 819-824.
  • 19. Lin E, C.S., Lowry SF., Systemik reapose to injury and metabolic support, “Brunicardi FC, Andersen DK, Billiar DR, Dunn DL, Hunter JG, Pollock RE (eds): . Principles of Surgery, 8th press p.3- 41, McGraw Hill, New York (2005).
  • 20. Staal-van den Brekel AJ, D.M., Schols AM, Buurman WA, Wouters EF., Increased restingenergy expenditure and weight loss are related to a systemic inflammatory responce in lung cancer patients. . J Clin Oncol, 1995. 13: p. 2600-2605.
  • 21. Tamura S, O.K., Mori K, et al. , Involvement of human interleukin 6 in experimental cachexia induced by a human uterine cervical carcinoma production, in vivo. Cytokine, 1995. 1: p. 1353-1358.
  • 22. Shenkin A, F.W., Series J et al., The serum interleukin-6 response to elective surgery. Lymphokine Res, 1989. 8(2): p. 123-7.
  • 23. Campbell KL, Makar KW, Kratz M, Foster-Schubert KE, McTiernan A, Ulrich CM (2009) A pilot study of sampling subcutaneous adipose tissue to examine biomarkers of cancer risk. Cancer Prev Res (Phila) 2(1):37–42. [PubMed: 19139016] .
  • 24. Campbell KL, Foster-Schubert KE, Makar KW, Kratz M, Hagman D, Schur EA, et al. (2013) Gene expression changes in adipose tissue with diet- and/or exercise-induced weight loss. Cancer Prev Res (Phila) 6(3):217–31. [PubMed: 23341572]
  • 25. Fiebig E, L.K., Arfors KE., Rapid leukocyte accumulation by "spontaneous" rolling and adhesion inthe exteriorized rabbit mesentery. Int J Microcirc Clin Exp, 1991. 10(2): p. 127-44.
  • 26. Perou CM, S.T., Eisen MB, van de Rijn M, Jeff rey SS, Rees CA, Pollack JR, et al., Molecular portraits of human breast tumours. Nature 2000. 406: p. 747-752.
  • 27. Taucher S, R.M., Mader RM, Gnant M, Dubsky P, Roka S, et al., Prognostic markers in breast cancer: the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer. Wien Klin Wochenschr, 2004. 116: p. 26-31.
  • 28. Schindlbeck C, H.P., Zerzer M, Jahns B, Rjosk D, Janni W, et al., Prognostic impact of Ki-67, p53, human epithelial growth factor receptor 2, topoisomerase IIalpha, epidermal growth factor receptor, and nm23 expression of ovarian carcinomas and disseminated tumor cells in the bone marrow. Int J Gynecol Cancer, 2007. 17: p. 1047-55.

The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers

Yıl 2023, , 253 - 262, 30.06.2023
https://doi.org/10.18663/tjcl.1310277

Öz

Amaç: Bu çalışmanın amacı, farklı meme cerrahisi tekniklerinin inflamatuar yanıt üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntemler: Çalışma Şubat 2013-Nisan 2013 tarihleri arasında Genel Cerrahi Kliniği'nde gerçekleştirildi.tru-cut veya insizyonel biyopsi ile meme kanseri tanısı konulan 18-70 yaş arası 42 hasta AJCC kriterlerine göre evre I ve II meme kanseri olarak değerlendirilerek cerrahi tedavi uygulandı. Bu prospektif çalışmada, tanımlayıcı istatistikler ortalama±standart sapma, yüzde ve frekans olarak verilmiştir.Grupların karşılaştırılmasında üç grubun karşılaştırılmasında Kruskal-wallis testi, iki grubun karşılaştırılmasında Mann-Whitney-U testi kullanıldı. Grup içi karşılaştırmada Wilcoxon testi kullanıldı. Gruplar arasındaki sayım değerlerinin karşılaştırılmasında ki-kare testi kullanıldı. %95 güven aralığındaki p<0,05 değeri istatistiksel olarak anlamlı kabul edildi. Korelasyonda; Pearson korelasyonu ve Spearman korelasyon testi kullanıldı.
Bulgular: Toplam olgu sayısı 42 idi. Çalışmaya alınan hastaların yaş ortalaması 52,54±12,7 idi.
Özellikle preoperatif ve postoperatif inflamatuvar belirteçlerinin karşılaştırılması açısından; Postoperatif IL-6 değerleri her üç grupta da preoperatif IL-6 değerlerinden anlamlı olarak yüksek bulundu(p=0,001), postoperatif lökosit sayısı da her üç grupta da anlamlı olarak yüksek bulundu (p=0,003, p=0,001, p =0.001).Ayrıca ameliyattan sonra her üç grupta da ameliyat öncesine göre CRP düzeylerinin anlamlı olarak arttığı bulundu. Preoperatif CRP düzeyleri açısından gruplar arasında fark bulunmazken, postoperatif dönemde lumpektomi ve aksiller diseksiyon uygulanan grupta CRP düzeyleri diğer gruplara göre daha yüksek bulundu(p=0,004).
Sonuç: Meme kanserinde seçilecek cerrahi yöntemlerde öncelikle travmanın şiddeti göz önünde bulundurularak inflamatuar reaksiyonları minimumda tutabilen ve hasta için onkolojik prensipleri tam olarak karşılayan yöntemler akılda tutulmalıdır.

Kaynakça

  • 1. Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy. Surg Endosc. 2003;17(2):342-50.
  • 2. Vlastos G., Verkooijen HM. Minimally invasive approaches for diagnosis and treatment of erly-stage breast cancer. The Oncologist 2007;12:1-10.
  • 3. Morrow M. Minimally invasive surgery for breast cancer. BMJ. 2009 19;338:845-846.
  • 4. Ito K, Kanai T, Gomi K, Watanabe T, Ito T Komatsu A et al. Endoscopic-assisted skin-sparing mastectomy combined with sentinel node biopsy. Aust NZJ Surg 2008;78:894-898
  • 5. Yamashita K, Shimizu K. Transaxillary retromammary route approach of video-assisted breast surgery enables the iner-side breast cancer to be resected for breast conserving surgery. Am J Surg 2008;196:578-581
  • 6. Ben-Eliyahu S. The price of anticancer intervention. Does surgery promote metastasis? Lancet Oncol. 2002;3(9):578-579.
  • 7. Goldfarb Y, Ben-Eliyahu S. Surgery as a risk factor for breast cancer recurrence and metastasis: mediating mechanisms and clinical prophylactic approaches. Breast Dis. 2006-2007;26:99-114.
  • 8. Vallejo R, Hord ED, Barna SA, Santiago-Palma J, Ahmed S. Prioperative immunosupression in cancer patients. J Environ Pathol Toxicol Oncol. 2003;22:139-146
  • 9. Brand JM, Kirchner H, Poppe C, Schmucker P. The effects of general anesthesia on human peripheral immune cell distribution and cytokine production. Clin Immunol Immunopathol. 1997 May;83:190-194.
  • 10. Page GG. Surgery-induced immunosupression and postoperative pain management. AACN Clin Issues 2005;16:302- 309; quiz 416-8.
  • 11. Yamauchi H, Kobayashi E, Yoshida T, Kiyozaki H, Hozumi Y, Kohiyama R, Suminaga Y, Sakurabayashi I, Fujimura A, Miyata M. Changes in immune-endocrine response after surgery. Cytokine. 1998;10(7):549-554.
  • 12. Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thörne A. Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999;43:146-152.
  • 13. Schietroma M, Carlei F, Cappelli S, Pescosolido A, Lygidakis NJ, Amicucci G Effects of cholecystectomy (laparoscopic versus open) on PMN-elastase. Hepatogastroenterology. 2007;54:342-345.
  • 14. Sietses C, Beelen RH, Meijer S, Cuesta MA. Immunological consequences of laparoscopic surgery, speculations on the cause and clinical implications. Langenbecks Arch Surg. 1999;384:250-258.
  • 15. Boomsma MF, Garssen B, Slot E, Berbee M, Berkhof J, Meezenbroek Ede J, Slieker W, Visser A, Meijer S, Beelen RH. Breast cancer surgery-induced immunomodulation. J Surg Oncol. 2010 Nov 1;102:640-648.
  • 16. McCoy JL, Rucker R, Petros JA. Cell-mediated immunity to tumor- associated antigens is a better predictor of survival in early stage breast cancer than stage, grade or lymph node status. Breast Cancer Res Treat 2000;60:227-234.
  • 17. Tschantz P, T.Y., Risk factors in elderly surgical patients: a prospective study. Swiss Surg., 1995. 3: p. 140-7.
  • 18. Schlos AMWJ, B.W., Staal-van den Brekel AJ, Dentener MA, Wouters EF. , Evidence for a relation between metabolic derangements and increased levels of imflammatory mediators in a group of patients with chronic obstructive pulmonary disease. Thorax, 1996. 51: p. 819-824.
  • 19. Lin E, C.S., Lowry SF., Systemik reapose to injury and metabolic support, “Brunicardi FC, Andersen DK, Billiar DR, Dunn DL, Hunter JG, Pollock RE (eds): . Principles of Surgery, 8th press p.3- 41, McGraw Hill, New York (2005).
  • 20. Staal-van den Brekel AJ, D.M., Schols AM, Buurman WA, Wouters EF., Increased restingenergy expenditure and weight loss are related to a systemic inflammatory responce in lung cancer patients. . J Clin Oncol, 1995. 13: p. 2600-2605.
  • 21. Tamura S, O.K., Mori K, et al. , Involvement of human interleukin 6 in experimental cachexia induced by a human uterine cervical carcinoma production, in vivo. Cytokine, 1995. 1: p. 1353-1358.
  • 22. Shenkin A, F.W., Series J et al., The serum interleukin-6 response to elective surgery. Lymphokine Res, 1989. 8(2): p. 123-7.
  • 23. Campbell KL, Makar KW, Kratz M, Foster-Schubert KE, McTiernan A, Ulrich CM (2009) A pilot study of sampling subcutaneous adipose tissue to examine biomarkers of cancer risk. Cancer Prev Res (Phila) 2(1):37–42. [PubMed: 19139016] .
  • 24. Campbell KL, Foster-Schubert KE, Makar KW, Kratz M, Hagman D, Schur EA, et al. (2013) Gene expression changes in adipose tissue with diet- and/or exercise-induced weight loss. Cancer Prev Res (Phila) 6(3):217–31. [PubMed: 23341572]
  • 25. Fiebig E, L.K., Arfors KE., Rapid leukocyte accumulation by "spontaneous" rolling and adhesion inthe exteriorized rabbit mesentery. Int J Microcirc Clin Exp, 1991. 10(2): p. 127-44.
  • 26. Perou CM, S.T., Eisen MB, van de Rijn M, Jeff rey SS, Rees CA, Pollack JR, et al., Molecular portraits of human breast tumours. Nature 2000. 406: p. 747-752.
  • 27. Taucher S, R.M., Mader RM, Gnant M, Dubsky P, Roka S, et al., Prognostic markers in breast cancer: the reliability of HER2/neu status in core needle biopsy of 325 patients with primary breast cancer. Wien Klin Wochenschr, 2004. 116: p. 26-31.
  • 28. Schindlbeck C, H.P., Zerzer M, Jahns B, Rjosk D, Janni W, et al., Prognostic impact of Ki-67, p53, human epithelial growth factor receptor 2, topoisomerase IIalpha, epidermal growth factor receptor, and nm23 expression of ovarian carcinomas and disseminated tumor cells in the bone marrow. Int J Gynecol Cancer, 2007. 17: p. 1047-55.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Genel Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Volkan Kınaş 0000-0002-6971-3979

Özgür Albuz 0000-0002-8534-1781

Hüsnü Hakan Mersin 0000-0001-7100-7750

Yayımlanma Tarihi 30 Haziran 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

APA Kınaş, V., Albuz, Ö., & Mersin, H. H. (2023). The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers. Turkish Journal of Clinics and Laboratory, 14(2), 253-262. https://doi.org/10.18663/tjcl.1310277
AMA Kınaş V, Albuz Ö, Mersin HH. The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers. TJCL. Haziran 2023;14(2):253-262. doi:10.18663/tjcl.1310277
Chicago Kınaş, Volkan, Özgür Albuz, ve Hüsnü Hakan Mersin. “The Effect of Surgical Treatment Option on Inflammatory Response in Breast Cancers”. Turkish Journal of Clinics and Laboratory 14, sy. 2 (Haziran 2023): 253-62. https://doi.org/10.18663/tjcl.1310277.
EndNote Kınaş V, Albuz Ö, Mersin HH (01 Haziran 2023) The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers. Turkish Journal of Clinics and Laboratory 14 2 253–262.
IEEE V. Kınaş, Ö. Albuz, ve H. H. Mersin, “The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers”, TJCL, c. 14, sy. 2, ss. 253–262, 2023, doi: 10.18663/tjcl.1310277.
ISNAD Kınaş, Volkan vd. “The Effect of Surgical Treatment Option on Inflammatory Response in Breast Cancers”. Turkish Journal of Clinics and Laboratory 14/2 (Haziran 2023), 253-262. https://doi.org/10.18663/tjcl.1310277.
JAMA Kınaş V, Albuz Ö, Mersin HH. The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers. TJCL. 2023;14:253–262.
MLA Kınaş, Volkan vd. “The Effect of Surgical Treatment Option on Inflammatory Response in Breast Cancers”. Turkish Journal of Clinics and Laboratory, c. 14, sy. 2, 2023, ss. 253-62, doi:10.18663/tjcl.1310277.
Vancouver Kınaş V, Albuz Ö, Mersin HH. The Effect of Surgical Treatment Option on inflammatory Response in Breast Cancers. TJCL. 2023;14(2):253-62.


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