Minimal Access Breast Surgery Accelerates Immune Recovery in Breast Cancer Patients Compared to Open Surgery: Study Finds

In the study involving 116 matched pairs, both groups exhibited initial immune suppression following surgery. However, patients who underwent MABS demonstrated a faster return to preoperative immune levels by postoperative day 7 (PostD7), the researchers reported in the World Journal of Surgical Oncology. In contrast, COBS patients showed slower recovery, with immune levels remaining below baseline at PostD7.

Breast cancer surgery, whether through minimal access or open techniques, aims to effectively remove cancerous tissue while minimizing the impact on surrounding healthy tissue. MABS, known for its smaller incisions and reduced tissue trauma, has been increasingly adopted in clinical practice due to potential benefits such as quicker recovery and reduced postoperative complications. However, research on the postoperative immune function associated with MABS remains limited.

To fill this knowledge gap, Hai Hu, Department of General Surgery, Third Hospital of Nanchang, Xi hu District, Nanchang City, Jiangxi Province, China, and colleagues aimed to assess the postoperative immune function in breast patients who underwent MABS or conventional open breast surgery.

For this purpose, the researchers retrospectively analyzed the medical records of 829 breast cancer patients treated either with COBS or MABS at a single hospital between 2020 and 2023. Among those, 116 matched pairs were obtained through 1:1 propensity score matching (PSM).

Flow cytometry was employed to assess the percentages of CD3+, CD4+, and CD8+ cells, along with the CD4+/CD8+ ratio, at three distinct time points: preoperative day 1 (PreD1), postoperative day 1 (PostD1), and postoperative day 7 (PostD7).

The study led to the following findings:

· Both the MABS and COBS groups demonstrated a significant reduction in the percentages of CD3+, CD4+, and CD8+ cells, along with the CD4+/CD8+ ratio, from PreD1 to PostD1.

· The MABS group showed a reversal of these parameters, returning to preoperative levels by PostD7.

· The COBS group showed an increase in these parameters from PostD1 to PostD7 but remained significantly lower than preoperative levels at PostD7.

The study's limitations are that the retrospective nature may have selection bias despite efforts to minimize it. Future multi-center, prospective studies with larger samples are essential. Assessing immune function at more time points and exploring additional indicators, including direct examination of tumor specimens, would enhance understanding and validate findings, underscoring the need for further research.

"Despite these limitations, our study offers evidence supporting MABS for mitigating postoperative immune suppression. Larger randomized clinical trials and mechanistic studies are needed to uncover MABS's immune-preserving mechanisms," the researchers concluded.

Reference:

Jiang, Q., Liao, J., Tan, J. et al. Comparison of minimal access and open breast surgery: a propensity score-matched study on postoperative immune function in breast cancer. World J Surg Onc 22, 183 (2024). https://doi.org/10.1186/s12957-024-03447-w