Background: In breast cancer, vascular endothelial growth factor C, transforming growth factorß, placental growth factor, and fibroblast growth factor (acidic and basic) promote angiogenesis and metastases. We tested the hypothesis that a propofol-paravertebral anesthetic (PPA) technique would attenuate postoperative changes in these angiogenic factors to a greater extent than balanced general anesthesia (GA) and morphine analgesia in women undergoing surgery for primary breast cancer. Method: Forty women with primary breast cancer undergoing surgical excision were randomized to receive either standard GA or PPA technique. Venous blood was sampled before and at 24 h after surgery and serum analyzed. The primary endpoint was a preoperative versus postoperative change in vascular endothelial growth factor C and transforming growth factor ß concentrations. Results: Using a visual analog scale (median [25–75% interquartile range]), PPA patients (1 [0–2]) had less pain at 2h (P 0.02) than did GA patients (3 [2–5]). The mean postoperative change in vascular endothelial growth factor C concentrations among GA patients was 733 versus 27 pg/ml for PPA patients (difference, 706 [97.5% CI, 280–1,130] pg/ml, P 0.001). In contrast, the mean postoperative change in transforming growth factor ß concentration among GA patients was 163 versus 146 pg/ml for PPA patients (difference, 309 [97.5% CI, 474 to 143] pg/ml, P 0.005). Concentrations of placental growth factor and fibroblast growth factor, both acidic and basic, were undetectable in serum.

Conclusion: Anesthetic technique influences serum concentrations of factors associated with angiogenesis in primary breast cancer surgery.