Impact of Awake Breast Cancer Surgery on Postoperative Lymphocyte Responses

In Vivo. 2019 Nov-Dec;33(6):1879-1884. doi: 10.21873/invivo.11681.


Background: Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia.

Materials and methods: Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3+, CD19+, CD4+, CD8+, CD16+CD56+ and CD4+/CD8+ ratio was examined at baseline and on postoperative days 1, 2 and 3.

Results: Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04).

Conclusion: In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia.

Keywords: Breast cancer; anaesthesia; awake surgery; cancer; conservative surgery; immune function; immunological; leukocytes; local anaesthesia; lymphocytes; surgery; white blood cell.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, CD / immunology
  • Breast / immunology
  • Breast Neoplasms / immunology*
  • Breast Neoplasms / surgery
  • Female
  • Humans
  • Leukocyte Count / methods
  • Lymphocytes / immunology*
  • Middle Aged
  • Postoperative Period
  • Prospective Studies
  • Wakefulness / physiology*


  • Antigens, CD