ANALYSIS OF THE EFFECT OF ERAS SPECIAL CARE ON INFLAMMATORY RESPONSE AND IMMUNE FUNCTION IN BREAST CANCER ATHLETIC PATIENTS

Abstract

Objective: Rapid recovery surgery aims to accelerate postoperative recovery, reduce stress and complications associated with surgery and shorten postoperative hospital stay. By applying concept of rapid rehabilitation surgery to design a perioperative process for breast cancer and comparing it with traditional perioperative process for breast cancer, we analyzed changes of postoperative inflammatory indexes, complications and quality of recovery score (QOR-40) of athletic patients with two different types of care, and assessed whether application of rapid rehabilitation process for breast cancer surgery athletic patients could reduce postoperative stress, trauma and accelerate recovery of organism. Methods: Ninety-six athletic patients with pathological biopsies of breast cancer were admitted to our hospital from September 2019 to January 2022. 54 of these patients who underwent breast cancer surgery entered accelerated recovery surgical procedure (ERAS group) and were compared with 42 breast cancer athletic patients who underwent traditional postoperative recovery pathway. An analysis was performed to compare differences in c-reactive protein and interleukin-6 at 24 and 72 hours postoperatively and according to different surgical approaches (total excision + anterior post, total excision + axillary clearance, breast conservation + anterior post, breast conservation + axillary clearance), and to collect complications within one month postoperatively using Clavien-Dindo classification of complications for ERAS and conventional groups. The difference in postoperative complication rates between athletic patients in fast recovery and those in traditional postoperative recovery route was observed and compared using independent sample t-tests. The QOR-40 scale was self-assessed by athletic patients on third postoperative day to see if QOR-40 score was better in Fast and Well than conventional. Results: (1) Comparison in terms of age, weight, height, tumor size and surgical method, p>0.05, while difference in surgical time. (2) Changes in inflammatory indexes: Comparison of ultrasensitive C-reactive protein (CRP) levels between quick-health and traditional: preoperative CRP levels were 1.22±1.22 in quick-health and 1.41±1.20 in traditional, postoperative CRP levels at 24 hours were 7.33±4.26 in quick-health and 24.58±10.45 in traditional. The postoperative CRP level at 72 hours was 22.41±20.10 in fast-health and 38.76+27.63 in traditional, P<0.05. The postoperative IL-6 level at 24 hours was 18.56±13.54 in fast-health and 29.27±13.37 in traditional, P<0.05. Comparison between athletic patients in Quick and Well and traditional: ① Total mastectomy + anterior post: CRP: pre-operative CRP in Quick and Well was 0.71±0.66, pre-operative CRP in traditional was 1.19±0.84, P>0.05, post-operative CRP at 24 hours in Quick and Well was 5.16±4.11, post-operative CRP at 24 hours in traditional was 24.05±7.83, P<0.05. IL-6: The preoperative IL-6 was 1.80±0.91 in fast-health and 1.90±0.72 in traditional. IL-6 at 24 hours postoperatively was 15.28±5.21 in fast-health and 26.59±19.57 in traditional. ② Total mastectomy + axillary clearance: CRP: preoperative CRP was 1.48±1.62 in quick-health and 1.06±0.63 in traditional. 24-hour postoperative CRP was 7.61±4.02 in quick-health and 24.58±11.64 in traditional. IL-6: preoperative IL-6 was 2.34±1.98 in fast recovery and 2.04±1.39 in traditional. The IL-6 at 24 hours postoperatively was 20.66±15.53 in fast-health and 28.75±8.88 in traditional, P>0.05. The IL-6 at 72 hours postoperatively was 8.73±8.64 in fast-health and 10.15±5.99 in traditional (iii) Total mastectomy + anterior post: CRP: preoperative CRP was 1.39±1.13 in fast-health and 1.30±0.57 in traditional, 24-hour postoperative CRP was 9.18±4.42 in fast-health and 31.69±13.62 in traditional, IL-6: preoperative IL-6 was 2.09±1.69 in fast-health and 1.64±0.30 in traditional. The IL-6 at 24 hours postoperative was 21.49±16.22 in fast recovery and 36.33+15.95 in traditional; IL-6 at 72 hours postoperative was 15.46+11.95 in fast recovery and 16.19±9.79 in traditional; IL-6 at 24 hours postoperative was 2.09±1.69 in fast recovery and 1.64±0.30 in traditional. ④ Total mastectomy + axillary clearing: CRP: preoperative CRP was 0.92±0.41 in quick-health and 2.07±1.86 in traditional. 24-hour postoperative CRP was 5.46+2.95 in quick-health and 22.05±9.31 in traditional. The postoperative CRP at 72 hours was 16.39+15.02 in fast-health and 44.03+29.26 in traditional, IL-6: preoperative IL-6 was 1.83±0.55 in fast-health and 1.79±0.38 in traditional. The postoperative IL-6 was 10.85±4.76 at 24 hours and postoperative 1L-6 was 29.22+11.43 at 24 hours in traditional, postoperative IL-6 was 6.85±5.15 at 72 hours in quick-health and postoperative IL-6 was 11.43±7.55 at 72 hours in traditional; (3) Incidence of complications: 54 cases in fast recovery, 6 cases in total, 42 cases in traditional, 12 cases in total. (4) Quality of recovery score (QOR-40): The mean QOR-40 score on third day after surgery was 174.34±14.35 in fast and healthy and 169.27±16.11 in traditional. When comparing five dimensions of QOR-40 scale between athletic patients in fast recovery and traditional, physical comfort level was 50.81±6.12 in fast recovery and 48.49±5.06 in traditional; in terms of physical condition: 39.31±4.25 in fast recovery and 38.61±5.51 in traditional; in terms of patient support: 30.47±3.28 in fast recovery and 30.08±2.87 in traditional; in terms of self-care ability: 22.95±1.95 in fast recovery and 28.55±2.89 in traditional. In terms of self-care ability: 22.95±1.85 in fast-health and 23.41±2.37 in traditional. Conclusion: Applying concept of accelerated rehabilitation surgery to design of perioperative process for breast cancer enabled athletic patients to reduce postoperative stress, reduce incidence of overall postoperative complications and stage 1 complications, and improve quality of postoperative recovery by lowering patient's postoperative inflammatory markers and accelerating patient's postoperative recovery.