PMID- 32616309 OWN - NLM STAT- MEDLINE DCOM- 20201109 LR - 20201109 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 125 IP - 5 DP - 2020 Nov TI - Neutrophil extracellular trapping and angiogenesis biomarkers after intravenous or inhalation anaesthesia with or without intravenous lidocaine for breast cancer surgery: a prospective, randomised trial. PG - 712-721 LID - S0007-0912(20)30345-7 [pii] LID - 10.1016/j.bja.2020.05.003 [doi] AB - BACKGROUND: Experimental and, retrospective, clinical data indicate that anaesthetic technique might influence the risk of metastasis after cancer surgery. Neutrophil extracellular trapping (NETosis) is an immunological mechanism strongly linked with increased metastatic risk. Similarly, vascular endothelial growth factor A is linked to angiogenesis implicated in recurrence. Therefore, we investigated the effect of four anaesthetic techniques on NETosis and angiogenic factors expression in women undergoing breast cancer resection. METHODS: Women (n=120) undergoing primary breast tumour resection were randomly assigned to receive one of four anaesthetics: sevoflurane (S), sevoflurane plus i.v. lidocaine (SL), propofol (P), and propofol plus i.v. lidocaine (PL). Venous blood was collected before induction and 20-28 h after operation. Neutrophil myeloperoxidase and citrullinated histone H3, biomarkers of NETosis, and biomarkers of angiogenesis were measured by enzyme-linked immunosorbent assay. RESULTS: Patient characteristic data and perioperative management did not differ between study groups. The anaesthetic technique including lidocaine decreased expression of citrullinated histone H3 compared with no lidocaine (109 [23] vs 125 [22] ng ml(-1), P=0.01 for SL and S and 98 [14] vs 130 [32] mg ml(-1), P=0.007, for PL and P, respectively). Similarly, myeloperoxidase was decreased by lidocaine (8.5 [3.4] vs 10.8 [1.8] ng ml(-1), P=0.03 for SL and S and 8.6 [3.1] vs 11.6 [2.5] ng ml(-1), P=0.01 for PL and P, respectively). Lidocaine also decreased expression of matrix metalloproteinase 3 (MMP3) but not MMP9, whichever anaesthetic was used. Vascular endothelial growth factor A concentrations were not significantly influenced by the anaesthetic technique. CONCLUSIONS: I.V. perioperative lidocaine decreased postoperative expression of NETosis and MMP3, regardless of general anaesthetic technique. This supports the hypothesis that i.v. lidocaine during cancer surgery of curative intent might reduce recurrence. CLINICAL TRIAL REGISTRATION: NCT02839668. CI - Copyright (c) 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Galos, Elena V AU - Galos EV AD - 1st Department of Anaesthesiology and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; EU COST Action 15204: European Cooperation in Science and Technology, The European Platform for Outcomes Research into Perioperative Interventions during Surgery for Cancer: The EURO-PERISCOPE Network. FAU - Tat, Tiberiu-Florin AU - Tat TF AD - Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania. FAU - Popa, Razvan AU - Popa R AD - Prof. Dr. Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania. FAU - Efrimescu, Catalin-Iulian AU - Efrimescu CI AD - Department of Anaesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; EU COST Action 15204: European Cooperation in Science and Technology, The European Platform for Outcomes Research into Perioperative Interventions during Surgery for Cancer: The EURO-PERISCOPE Network. FAU - Finnerty, Dylan AU - Finnerty D AD - Department of Anaesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; EU COST Action 15204: European Cooperation in Science and Technology, The European Platform for Outcomes Research into Perioperative Interventions during Surgery for Cancer: The EURO-PERISCOPE Network. FAU - Buggy, Donal J AU - Buggy DJ AD - Department of Anaesthesiology & Perioperative Medicine, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Department of Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; EU COST Action 15204: European Cooperation in Science and Technology, The European Platform for Outcomes Research into Perioperative Interventions during Surgery for Cancer: The EURO-PERISCOPE Network. FAU - Ionescu, Daniela C AU - Ionescu DC AD - 1st Department of Anaesthesiology and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; EU COST Action 15204: European Cooperation in Science and Technology, The European Platform for Outcomes Research into Perioperative Interventions during Surgery for Cancer: The EURO-PERISCOPE Network. Electronic address: daniela_ionescu@umfcluj.ro. FAU - Mihu, Carmen M AU - Mihu CM AD - Department of Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. LA - eng SI - ClinicalTrials.gov/NCT02839668 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20200629 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 RN - 0 (Anesthetics, Local) RN - 0 (Biomarkers) RN - 0 (Histones) RN - 98PI200987 (Lidocaine) RN - EC 1.11.1.7 (Peroxidase) RN - EC 3.4.24.17 (MMP3 protein, human) RN - EC 3.4.24.17 (Matrix Metalloproteinase 3) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Anesthesia, Inhalation MH - Anesthesia, Intravenous MH - Anesthetics, Local/*pharmacology MH - Biomarkers/blood MH - Breast Neoplasms/*surgery MH - *Extracellular Traps MH - Female MH - Histones/blood MH - Humans MH - Lidocaine/*pharmacology MH - Matrix Metalloproteinase 3/blood MH - Middle Aged MH - Neoplasm Recurrence, Local/prevention & control MH - Neovascularization, Pathologic/*blood MH - Peroxidase/blood MH - Prospective Studies OTO - NOTNLM OT - NETosis OT - biomarker OT - breast cancer OT - lidocaine OT - neutrophil extracellular trapping OT - propofol OT - recurrence OT - sevoflurane COIS- Declarations of interest DJB is an editorial board member of the British Journal Anaesthesia. All other authors declare that they have no conflict of interest. EDAT- 2020/07/04 06:00 MHDA- 2020/11/11 06:00 CRDT- 2020/07/04 06:00 PHST- 2020/03/07 00:00 [received] PHST- 2020/05/01 00:00 [revised] PHST- 2020/05/05 00:00 [accepted] PHST- 2020/07/04 06:00 [pubmed] PHST- 2020/11/11 06:00 [medline] PHST- 2020/07/04 06:00 [entrez] AID - S0007-0912(20)30345-7 [pii] AID - 10.1016/j.bja.2020.05.003 [doi] PST - ppublish SO - Br J Anaesth. 2020 Nov;125(5):712-721. doi: 10.1016/j.bja.2020.05.003. Epub 2020 Jun 29.