Postoperative Immunosuppression Following Breast-Conserving Surgery vs. Mastectomy: The Role of Surgical Injuries and Intraoperative Sympathetic Activation

Breast cancer is the second most prevalent cancer among all types of cancers. Objectives: To evaluate the role of surgical tissue injury and intraoperative sympathetic activation in postoperative immunosuppression after breast-conservative surgery and mastectomy. Methods: This prospective/observational study investigated 36 breast cancer patients in the Department of Surgery Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat from June 2022 to May 2023. Patients who were on schedule to undergo either mastectomy or breast-conserving surgery enrolled. Patients were categorized into two groups; Group I (breast-conserving surgery group n=18) and Group II (mastectomy group n=18). The intraoperative sympathetic activation, plasma Damage-associated molecular patterns, and postoperative immune function were compared in both groups. Descriptive statistics were done using SPSS version 28.0. Results: The overall mean age and body mass index of Group I and Group II were 62.8 ± 8.9 vs. 60.6 ± 10.6 years and 26.9 ± 3.8 vs. 25.8 ± 3.7 kg/m2, respectively. The overall duration of surgery (minutes) was 56 ± 18 and 85 ± 22, respectively. The prominent indication for surgery in Group I and Group II was Invasive carcinoma 17 (94.4%) and 11 (61.1%), respectively. The concentration of plasma alarmins and IL-6 was significantly higher in patients who underwent mastectomy as compared to breast-conserving surgery. Conclusions: It was concluded that differences in Damage-associated molecular patterns release and intraoperative sympathetic activation between mastectomy and breast-conserving surgery may influence, and potentially contribute to, postoperative immune homeostasis to improve survival seen after breast-conserving surgery.