Skip to main content
. Author manuscript; available in PMC: 2019 Jun 1.
Published in final edited form as: Surg Oncol. 2018 May 5;27(2):266–274. doi: 10.1016/j.suronc.2018.05.001

Table 1.

This table is a summary of previous studies that have looked at various endpoints when different perioperative interventions have been used in breast cancer surgery. Recurrence-Free Survival (RFS), General Anesthesia (GA), Paravertebral Block (PVB), Disease-free (DFS), Local regional recurrence (LRR), distant recurrence-free survival (DRFS), breast cancer-specific survival (BCSS) and overall survival (OS). SHAM: Sham block group

Study Topic Study Year Study Type Study Groups Total patients (n) Breast Cancer Type and/or Surgery End Points Hazard Ratio (CI) or other statistical measures
Paravertebral block and breast cancer survival Exadaktylos 2006 Retrospective GA + PVB analgesia vs GA + opiod-based analgesia 129 Palpable breast lesion, extesnsive breast surgery with axillary node clearance RFS RFS: adjusted 0.21 [0.06, 0.71]).
NSAIDS and recurrence Forget 2010 Retrospective NSAIDs versus no NSAIDS 327 Masectomy with axillary node dissection RFS unadjusted:.41 (0–1.19, 95%) adjusted: .37 (0–.79, 95%)
Quality of Recovery with paravertebral block in breast surgery Li 2011 Prospective GA vs GA plus ultrasound-guided PVB 40 Unilateral modified radical mastectomy Quality of Recovery (QoR) QoR postoperative 6 hr . (p<.0001), POD1 p=0.0079
Paravertebral blocks and postoperative pain, nausea Aufforth 2012 Retrospective PVB vs no PVB 337 Primary breast cancer surgery Postoperative pain and nausea No difference in morphine equivalents (P = 0.234) or in pain scores (P = 0.521) between the 2 groups in the PACU; no difference in amount of morphine equivalents given on POD0 (P = 0.8); no difference in postoperative nausea (p= .746)
Intraoperative NSAID vs no intraoperative NSAIDs and preoperative neutrophil:lymphocyte ratio Forget 2014 Retrospective NSAIDs vs no NSAIDS 720 Conservative Breast Cancer Surgery DFS, OS DFS: .57 (0.37–0.89), OS: .35 (0.17–0.70)
Sevoflurane vs propofol Enlund 2014 Retrospective Propofol vs sevoflurane 2838 (2168 Breast) Breast cancer or colorectal cancer surgery OS Univariate: 0.84 (0.65–1.08), Multivariate: 1.31 (.93–1.91)
Paravertebral blocks and postoperative pain, nausea Fahy (Aodhnait) 2014 Retrosepctive PVB vs no PVB 526 Masectomy +/− reconstruction Discharge from hospital within 36 h, length of stay in the PACU, opioid and antiemetic use on POD0 and POD1 Need for any postoperative antiemetic was less frequent in the PVB group (39 vs. 57 %, p<0.0001). Day of surgery opioid use was lower in the PVB group than the non-PVB group (mean ± SD 40.1 ± 15.2 vs.47.6 ± 17.7 morphine equivalents, p<0.0001). proportion of patients discharged within 36 h of surgery was significantly higher in the PVB group (55 vs. 42 %, p = 0.0031).
Immune infiltration in paravertebral vs general anesthesia Desmond 2015 Randomized Control Propofol-paravertebral anesthetic with continuing analgesia or a balanced general anaesthesia with opioid analgesia 30 Surgery for primary breast cancer Immune cell infiltration: CD56 (NK cells), CD4 (T helper cells), CD8 (T suppressor cells) and CD68 (macrophages) CD56 lower in GA (p=0.015), CD4 lower in CA versus PPA (p=0.03), CD8 (p=0.24), CD68 (p=0.74)
Local and regional anesthesia on breast cancer recurrence rates Starnes-Ott 2015 Retrospective, observational cohort Outpatient procedures with paravertebal block with GA vs GA alone 358 0-III breast cancer patients Recurrence 1.84 (95% CI, 0.34–10.08).
Propofol vs desflurane on immune cells Woo 2015 Prospective, randomized Patients receiving propofol vs desflurane 40 Patients undergoing undergoing mastectomy, axillary node dissection or wide local tumor excision Th1/Th2 ratio (IL-2/IL4) on the first postoperative day was primary enpoint Both propofol and desflurane anesthesia preserved the IL-2/IL-4 and CD4+ /CD8+ T cell ratio.
Paravertebral and intraoperative/postoperative opioid Pei 2015 Randomized, Controlled, Single-Center Ultrasound assisted thoracic paravertebral block with propofol versus sham subcutaneous local anesthetic followed by GA with fentanyl and sevoflurane 247 Unilateral breast cancer resection Volatile anesthetic dose, intraoperative ffentanyl and propofol doses, intensity of most severe surgical site pain in first two hours post op (VAS score) Propofol dose [mg]: ratio of mean 2.6 (CI 98.75% 2.2,3.1), Sevoflurane consumption .35 (.30,.30); Intraoperative fentanyl .38 (.32,.44), VAS for pain .79 (.64,.97) all have p values <.001
Local and regional anesthesia and recurrence rates in breast cancer Tsigonis 2016 Retrospective Local and regional anesthesia vs GA 1107 0-III breast cancer patients OS,DFS,LRR OS: .81 (.59–1.10), DFS: .91 (.55–1.76), LRR (1.73 (.83–3.63)
Paravertebral blocks and survival Cata 2016 Retrospective GA + PVB analgesia vs GA + opioid-based analgesia 792 Nonmetastatic breast cancer, breast cancer surgery OS, RFS Matched multivariate RFS [1.60 (0.81–3.16); OS 1.28 (0.55–3.01)
Propofol vs sevoflurane Lee 2016 Retrospective Patients undergoing modified radical masectomy receiving propofol or sevoflurane 363 Modified Radical Masectomy RFS, OS RFS: Univariate: .550 (.311–.973), Multivariate: .478 (.265–.862); OD: NSD (p=.383)