Anesthetics and long-term survival after cancer surgery—total intravenous versus volatile anesthesia: a retrospective study

Hong, Boohwi; Lee, Sun Yeul; Kim, Yeojung; Lee, Minhee; Youn, Ann Misun; Rhim, Hyun Chul; Hong, Seok-Hwan; Kim, Chongam; Yoon, Seong‐Ho; Lim, Chang Su

doi:10.1186/s12871-019-0914-4

Cited by 33 publications

(33 citation statements)

References 35 publications

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“…There is inconsistent evidence concerning effect of inhalational anesthetic agents on proliferation of cancer [ 2 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. There are two main mechanisms by which inhaled anesthetics affect outcomes of cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Anesthetic methods have a variety of effects on enhancement of pro-tumorigenic cellular signaling, and humoral and cell mediated immunity. These influences could be comprehended an impact of type of anesthetics on long-term prognosis of cancer [ 2 , 14 ]. Reviews of current clinical practice describe that most of anesthesiologists commonly prefer volatile anesthetic agents such as the sevoflurane [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are several clinical trials on effects of volatile anesthetic agent on cancer cell proliferation, but they are mostly retrospective studies, and a few RCTs [ 2 , 14 , 15 , 16 , 17 , 18 , 19 ]. That reports were evaluated only indirect effects.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Sevoflurane on Lewis Lung Carcinoma Cell Proliferation In Vivo and In Vitro

et al. 2021

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Background and objectives: There are several studies that sevoflurane could enhance proliferation of cancer cells, while others suggest no effect on clinical outcome. We conducted in vivo and in vitro experiments to investigate the effects of sevoflurane, a volatile anesthetic, on proliferation and outcomes of Lewis lung carcinoma (LLC) cells. Materials and Methods: A total of 37 mice were injected with LLC cells to compare the tumor size and survival of the sevoflurane exposed group (sevo group) and control group. The sevo group was exposed to 2% sevoflurane and 4 L/min of oxygen for 1 h per day 3 times per week, and the control group was exposed only to 4 L/min of oxygen. In vitro study, 12 plates incubated with LCC cells. 6 plates were exposed to 2% sevoflurane for 1 hr/day for 3 days and 6 plates were not exposed, and cell proliferation was compared after 3 days. Results: There were no significant differences in survival or tumor size between mice exposed to sevoflurane and control mice (survival: 29.06 ± 4.45 vs. 28.76 ± 3.75, p = 0.836; tumor size: 0.75 (0.41–1.02) vs. 0.49 (0.11–0.79), p = 0.153). However, in vitro study, the proliferation of LLC cells exposed to sevoflurane increased by 9.2% compared to the control group (p = 0.018). Conclusions: Sevoflurane (2 vol%) exposure could promote proliferation of LLC cells in vitro environment, but may not affect proliferation of LLC cells in vivo environment. These results suggest that in vitro studies on the effects of anesthetics on cancer may differ from those of in vivo or clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Sevoflurane on Lewis Lung Carcinoma Cell Proliferation In Vivo and In Vitro

et al. 2021

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“…Hong et al[ 133 ] found that cancer patients treated with volatile inhaled anesthesia had a 5-year overall survival rate similar to those on total intravenous anesthesia. The ENIGMA-II trial did not show negative effects of nitrous oxide on cancer recurrence or mortality[ 134 ].…”

Section: Perioperative Carementioning

confidence: 99%

Critically ill patients with cancer: A clinical perspective

Martos-Benítez

Soler-Morejón

Lara-Ponce

et al. 2020

WJCO

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Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.

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“… 17 Previous retrospective human studies have shown differing results with some indicating a benefit of propofol-based total intravenous anesthesia versus inhaled volatile anesthesia in cancer surgery, versus others which found no such benefit. 18 - 29 Independent of anesthetic choice, the stress response and inflammation secondary to surgical stimulation appears to increase the likelihood of metastasis and recurrence, which may explain the protective effect of regional anesthesia 7 , 30 , 31 ( Figure 1 ). Opioids appear to be detrimental based on in-vitro and animal studies as a result of decreased NK-cell activity and promotion of angiogenesis by VEGF upregulation.…”

Section: Background and Significancementioning

confidence: 99%

The Intersection of Regional Anesthesia and Cancer Progression: A Theoretical Framework

et al. 2020

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The surgical stress and inflammatory response and volatile anesthetic agents have been shown to promote tumor metastasis in animal and in-vitro studies. Regional neuraxial anesthesia protects against these effects by decreasing the surgical stress and inflammatory response and associated changes in immune function in animals. However, evidence of a similar effect in humans remains equivocal due to the high variability and retrospective nature of clinical studies and difficulty in directly comparing regional versus general anesthesia in humans. We propose a theoretical framework to address the question of regional anesthesia as protective against metastasis. This theoretical construct views the immune system, circulating tumor cells, micrometastases, and inflammatory mediators as distinct populations in a highly connected system. In ecological theory, highly connected populations demonstrate more resilience to local perturbations but are prone to system-wide shifts compared with their poorly connected counterparts. Neuraxial anesthesia transforms the otherwise system-wide perturbations of the surgical stress and inflammatory response and volatile anesthesia into a comparatively local perturbation to which the system is more resilient. We propose this framework for experimental and mathematical models to help determine the impact of anesthetic choice on recurrence and metastasis and create therapeutic strategies to improve cancer outcomes after surgery.

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Anesthetics and long-term survival after cancer surgery—total intravenous versus volatile anesthesia: a retrospective study

Cited by 33 publications

References 35 publications

Effects of Sevoflurane on Lewis Lung Carcinoma Cell Proliferation In Vivo and In Vitro

Effects of Sevoflurane on Lewis Lung Carcinoma Cell Proliferation In Vivo and In Vitro

Critically ill patients with cancer: A clinical perspective

The Intersection of Regional Anesthesia and Cancer Progression: A Theoretical Framework

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