Email this article Comparison Of Postoperative Systemic Immune-Inflammatory Index (SII) After Modified Rsdical Mastectomy (MRM) In Breast Cancer Patient Sundergoing Epiduralversus General Anesthesia
Abstract
Modified Radical Mastectomy (MRM) may induce a systemic inflammatory response that can affect postoperative recovery in patients with breast cancer. The Systemic Immune-Inflammatory Index (SII) is an inflammatory biomarker calculated from platelet, neutrophil, and lymphocyte counts. This study aimed to compare postoperative changes in SII among breast cancer patients undergoing MRM who received epidural anesthesia and general anesthesia at Ibnu Sina YW-UMI Hospital. This retrospective analytical observational study used a comparative approach based on medical records of breast cancer patients who underwent MRM between January and December 2024. SII was calculated using the formula (platelet count × neutrophil count)/lymphocyte count, while the change in SII was defined consistently as the postoperative SII minus the preoperative SII (?SII = SII postoperative ? SII preoperative). Statistical analyses included the paired t-test, Wilcoxon test, and Mann–Whitney test according to data distribution. A total of 36 patients were included, comprising 10 patients who received epidural anesthesia and 26 who received general anesthesia. In the epidural group, the mean SII decreased from 839.04 preoperatively to 477.04 postoperatively. In contrast, the mean SII in the general anesthesia group increased from 742.28 to 1,487.24. The comparison of postoperative SII changes between the two anesthesia groups showed a statistically significant difference (p<0.001). These findings indicate different postoperative SII dynamics following MRM between patients receiving epidural and general anesthesia. However, the findings should be interpreted cautiously because of the retrospective design, unequal group sizes, and potential confounding factors that were not fully controlled. Further prospective studies with standardized postoperative blood sampling and adjustment for relevant perioperative confounders are warranted.
Keywords
Full Text:
full textReferences
World Health Organization, Menon G, Alkabban FM, Ferguson T. Breast Cancer [Internet]. Newsroom. StatPearls [Internet]: StatPearls Publishing; 2024 [cited 2025 Jul 2]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482286/
Christian JS, Adiputra PAT, Wiargitha IK. Perbandingan Pemakaian Satu Drain dengan Dua Drain Aktif Terhadap Volume Seroma dan Lama Pemakaian Drain Paska Modified Radical Mastectomy di RSUP Sanglah Denpasar. JBN (Jurnal Bedah Nasional) [Internet]. 2021 Jul 17;5(2):46–56. Available from: https://ojs.unud.ac.id/index.php/jbn/article/view/72298
Ikhsania, Yuswanto TJA, Tyas MDC, Martiningsih W. Perawatan Luka Berbasis Teori Florence untuk Mendukung Penyembuhan Luka Fase Inflamasi Pasien Pasca Operasi Laparatomi. J Penelit Kesehat Suara Forikes [Internet]. 2024;15(September):407–10. Available from: https://forikes-ejournal.com/index.php/SF/article/download/sf15311/15311
Hermanns H, Bos EME, van Zuylen ML, Hollmann MW, Stevens MF. The Options for Neuraxial Drug Administration. CNS Drugs [Internet]. 2022 Aug 15;36(8):877–96. Available from: https://link.springer.com/10.1007/s40263-022-00936-y
Chandradewi MR, Manuaba IBTW, Adiputra PAT. Faktor yang Mempengaruhi Rekurensi Pada Pasien Kanker Payudara Pasca Modified Radical Mastectomy di RSUP Prof. Dr. I G.N.G Ngoerah. Intisari Sains Medis [Internet]. 2022 Dec 7;13(3):690–3. Available from: https://isainsmedis.id/index.php/ism/article/view/1544
Solikhah, Suwarno, Agustin H, Astuti FD, Safitri N, Sulistyani N, et al. Peningkatan Kapasitas Pendamping Pasien Kanker dan Kualitas Hidup Penyintas Kanker. Yogyakarta: UAD Press; 2024.
Gultekin A, Sahin A, Akgul M, Yildirim I, Altinoz K, Baran O, et al. The Effect of Epidural Analgesia Added to General Anesthesia on Systemic Immune-Inflammation Index in Radical Prostatectomy Surgery. Niger J Clin Pract [Internet]. 2022 Jun;25(6):855–60. Available from: https://journals.lww.com/10.4103/njcp.njcp_1858_21
Yan X, Li G. Preoperative Systemic Immune-Inflammation Index Predicts Prognosis and Guides Clinical Treatment in Patients with Non-Small Cell Lung Cancer. Biosci Rep [Internet]. 2020 Mar 27;40(3):1–30. Available from: https://portlandpress.com/bioscirep/article/40/3/BSR20200352/222367/Preoperative-systemic-immune-inflammation-index
Zhang Y, Lu J, Qin M, Xu M, Luo W, Li B, et al. Effects of Different Anesthesia Methods on Postoperative Immune Function in Patients Undergoing Gastrointestinal Tumor Resection. Sci Rep [Internet]. 2023 Jan 5;13(1):243. Available from: https://www.nature.com/articles/s41598-023-27499-2
Dulgeroglu M, Firat AC, Araz C, Candan S. The Effect of Anesthesia Technique on Tumor Reccurrence Rate After Mastectomy. Int J Res Med Sci [Internet]. 2020 Apr 27;8(5):1692. Available from: https://www.msjonline.org/index.php/ijrms/article/view/8055
Dourado AT, Albuquerque AV de, Sena DFR de, Aguiar JL de A. The Impact of Anesthetic Techniques on Breast Cancer Recurrence: A Systematic Review of Clinical Evidence. Mastology [Internet]. 2021;31:1–9. Available from: https://www.mastology.org/wp-content/uploads/2021/01/MAS_2021024_AOP.pdf
Lin EJ, Prost S, Lin HJ, Shah S, Li R. Combined General/Epidural Anesthesia vs. General Anesthesia on Postoperative Cytokines: A Review and Meta-Analysis. Cancers (Basel) [Internet]. 2025 May 15;17(10):1667. Available from: https://www.mdpi.com/2072-6694/17/10/1667
Wang C, Fan S, Gu D, Deng J, Ma B, Xie L, et al. Effect of Ultrasound-Guided Transverse Abdominal Plane Block on Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune Inflammation Index in Patients Undergoing Radical Resection of Endometrial Carcinoma. Klisic A, editor. PLoS One [Internet]. 2024 Dec 5;19(12):e0315175. Available from: https://dx.plos.org/10.1371/journal.pone.0315175
Liberty IA. Metode Penelitian Kesehatan. Pekalongan: Penerbit NEM; 2024. 27–35 p.
Agnesia Y, Sari SW, Nu’man H, Ramadhani DW, Nopianto. Buku Ajar Metode Penelitian Kesehatan. Pekalongan: Penerbit NEM; 2023.
Hardani, Andriani H, Utami EF, Fardani RA, Sukmana DJ, Auliya NH, et al. Buku Metode Penelitian Kualitatif dan Kuantitatif. Cetakan 1. Abadi H, editor. Yogyakarta: CV. Pustaka Ilmu Group Yogyakarta; 2020. 245 p.
Andi Herawati, Syamsu Rijal, Arsal ASF, Reeny Purnamasari, Abdi DA, Syarifuddin Wahid. Karakteristik Kanker Panyudara. Fakumi Med J J Mhs Kedokt [Internet]. 2021 Oct 31;1(1):44–53. Available from: https://fmj.fk.umi.ac.id/index.php/fmj/article/view/76
Zhang Y, Sun Y, Zhang Q. Prognostic Value of The Systemic Immune-Inflammation Index in Patients with Breast Cancer: A Meta-Analysis. Cancer Cell Int [Internet]. 2020 Dec 9;20(1):224. Available from: https://cancerci.biomedcentral.com/articles/10.1186/s12935-020-01308-6
Zhang H, Guo K, Sun X, Liu Y, Zhong Z, Zhou W, et al. Impact of Anesthesia Methods on Perioperative Systemic Inflammation and Long-Term Outcomes in Patients Undergoing Surgery For Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Ann Transl Med [Internet]. 2021 Jan;9(1):49–49. Available from: https://atm.amegroups.com/article/view/56373/html
Kristiono E, Musba AMT, Salahuddin A, Gaus S, Hisbullah, Rum M. Pengaruh Erector Spinae Plane Block (ESPB) dengan Stabilitas Hemodinamik dan Kadar Kortisol Serum pada Operasi Tulang Belakang. Maj Anest Crit Care [Internet]. 2023 Jun 27;41(2):110–6. Available from: https://macc.perdatin.org/index.php/my-journal/article/view/302
Chen L. Perioperative Inflammation and Immune Response in Anesthesia: Implications for Recovery and Postoperative Outcomes. J Cardiothorac Vasc Anesth [Internet]. 2025 Nov;25:01142–5. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1053077025011425
Vrbanovi? Mijatovi? V. The Effect of Regional vs. General Anesthesia on the Immune Response in Breast Cancer Surgery: Anarrative Review of the Literature. Acta Clin Croat [Internet]. 2022;61(Suppl. 2):115–20. Available from: https://hrcak.srce.hr/clanak/411616
Brescia F, Favero A, Segatto I, Massarut S, Zanier C, Fabiani F, et al. Impact of Opioid-Free General Anesthesia with Locoregional Blocks During Breast Cancer Surgery on Systemic Inflammatory Response: Results From a Randomized Controlled Trial. Reg Anesth Pain Med [Internet]. 2025 Jun 25;1(1):1–11. Available from: https://rapm.bmj.com/lookup/doi/10.1136/rapm-2025-106504
Liu W, Wu L, Zhang M, Zhao L. Effects of General Anesthesia with Combined Epidural Anesthesia on Inflammatory Response in Patients with Early Stage Gastric Cancer Undergoing Tumor Resection. Exp Ther Med [Internet]. 2019 Oct 29;17:35–40. Available from: http://www.spandidos-publications.com/10.3892/etm.2018.6898
Ebo DG, Van der Poorten ML, Elst J, Van Gasse AL, Mertens C, Bridts C, et al. Immunoglobulin E Cross-Linking or MRGPRX2 Activation: Clinical Insights From Rocuronium Hypersensitivity. Br J Anaesth [Internet]. 2021 Jan;126(1):e27–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0007091220308382
DOI: https://doi.org/10.32502/sm.v17i1.10955
Refbacks
- There are currently no refbacks.
Copyright (c) 2026 Dewi Fitri Hastuti, Faisal Sommeng, Darariani Iskandar, Fendy Dwimartyono, Reeny Purnamasari Juhamran
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Syifa Medika: Jurnal Kedokteran dan Kesehatan indexed by :
Syifa Medika: Jurnal Kedokteran dan Kesehatan Published by Faculty of Medicine, University of Muhammadiyah, Palembang, South Sumatra. This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
________________________________________________
Syifa Medika: Jurnal Kedokteran dan Kesehatan
Faculty of Medicine, University of Muhammadiyah Palembang
Jl. KH. Balqi Jl. Banten II, 13 Ulu, Kec. Seberang Ulu II, Palembang City, South Sumatera 30263
E-Mail: sifa_medika@um-palembang.ac.id