Prajoko, Yan Wisnu and HARAHAP, MOHAMAD SOFYAN and Muhtar, Ahmad Za'im (2024) PENGARUH TEKNIK ANESTESI TERHADAP BIOMARKER TUMOR NECROSIS FACTOR ALPHA (TNF-α) DAN RASIO LEBAR DISTRIBUSI SEL DARAH MERAH TERHADAP PLATELET (RPR) PADA OPERASI KANKER PAYUDARA. Masters thesis, Universitas Diponegoro.

Text (AHMAD ZA'IM MUHTAR MAHFUDDIN-22010122410013-TESIS-ABSTRAK) AHMAD ZA'IM MUHTAR MAHFUDDIN-22010122410013-TESIS-ABSTRAK.pdf Download (333kB)

Abstract

Background: Breast cancer has a relatively high incidence, around 20% of all malignancies. Breast cancer surgery triggers inflammation and immunosuppression. Monocytes and macrophages will release pro-inflammatory cytokines such as TNF-α, IL-1, and IL-6., and also RPR. The anesthetic technique commonly used in breast cancer surgery is PECS II combination with general anesthesia (GA). Behind GA's analgetic benefits, it has a negative effect on cancer prognosis.
Method: This is an experimental analytical research with a pre-post test randomized control design. The subjects were 48 breast cancer patients who underwent breast removal surgery at RSUP Dr. Kariadi in August – October 2023 which meet the research criteria. The data was processed with SPSS for Windows software and analyzed.
Results: Postoperative TNF-α levels were higher in the group with GA (8.15 ± 5.31) compared with PECS block (6.21 ± 5.58). The difference between TNF-α levels was found to be higher in the group with PECS block (-5.08 ± 3.70). Postoperative RPR levels were higher in the group with GA (0,64 ± 0,28) than PECS block (0,50 ± 0,20). The difference between RPR levels was found to be higher in the group with PECS block (-0,07 ± 0,19).
Conclusion: Inflammatory biomarkers, in the form of TNF-α and red blood cell to platelet distribution width ratio (RPR) in breast cancer surgery were found to be lower in the combination of PECS block II with general anesthesia than in general anesthesia.
Key words: Breast Cancer, TNF-α, RPR, General Anesthesia, PECS block II

Latar Belakang: Kanker payudara mempunyai angka kejadian yang relatif tinggi yaitu sekitar 20% dari seluruh keganasan. Operasi kanker payudara memicu peradangan dan imunosupresi. Monosit dan makrofag akan melepaskan sitokin proinflamasi seperti TNF-α, IL-1, dan IL-6, serta RPR. Teknik anestesi yang umum digunakan dalam operasi kanker payudara adalah kombinasi PECS II dengan anestesi umum (GA). Di balik manfaat analgetik GA, ia mempunyai efek negatif pada prognosis kanker.
Metode: Penelitian ini merupakan penelitian eksperimental analitik dengan desain pre-post test randomized control design. Subjek penelitian adalah 48 orang pasien kanker payudara yang menjalani operasi pengangkatan payudara di RSUP Dr. Kariadi pada bulan Agustus – Oktober 2023 yang memenuhi kriteria penelitian. Data diolah dengan software SPSS for Windows dan dianalisis.
Hasil: Kadar TNF-α pasca operasi lebih tinggi pada kelompok dengan GA (8,15 ± 5,31) dibandingkan dengan blok PECS (6,21 ± 5,58). Perbedaan kadar TNF-α ditemukan lebih tinggi pada kelompok dengan blok PECS (-5,08 ± 3,70). Kadar RPR pasca operasi lebih tinggi pada kelompok GA (0,64 ± 0,28) dibandingkan blok PECS (0,50 ± 0,20). Perbedaan kadar RPR ditemukan lebih tinggi pada kelompok dengan blok PECS (-0,07 ± 0,19).
Kesimpulan: Biomarker inflamasi berupa TNF-α dan rasio lebar distribusi sel darah merah terhadap trombosit (RPR) pada operasi kanker payudara ditemukan lebih rendah pada kombinasi PECS blok II dengan anestesi umum dibandingkan dengan anestesi umum.
Kata kunci: Kanker Payudara, TNF-α, RPR, Anestesi Umum, PECS blok II

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