Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis: Review of current evidence and practice

Abstract

Newer developments in the field of chemotherapeutic drug regimes, radiotherapy, and surgical techniques have improved the prognosis of cancer patients tremendously. Today increasing numbers of patients with aggressive disease are posted for surgical resection. The advances in reconstructive flap surgery offer the patient a near normal dignified postresection life. Hence, the expectations from the patients are also on the rise. Anesthetic challenges known in oncosurgery are that of difficult airway, maintenance of hemodynamics and temperature during long surgical hours, pain management, and postoperative intensive care management. But, recently acquired data raised the possibility of the anesthetic technique and conduct of perioperative period as a possible contributory factor in the growth and possible recurrence of the primary tumor. The foundation of the concept is somewhat fragile and not supported by conclusive evidence. In fact, like any other controversial topic in medicine, contradictory reports of the favorable effects of anesthetic technique and medications are plenty in the literature. This is the basis of our article where we have analyzed the current evidence available in the literature and how these and the forthcoming large scale studies may revolutionize the practice of oncoanesthesia.

<p>Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence</p>

“…One of the greatest effects of opioids on immune system is the inhibition of the proliferation and differentiation of T-lymphocyte, besides promoting their apoptosis, too. 30,31 For instance, morphine, fentanyl, alfentanil and sufentanil all decrease the NK cell activity, [30][31][32] while remifentanil was shown to completely overwhelm the lymphocyte proliferation and the NK cell activity in rats. 33 In particular, morphine reduces NK cell activity to an extent proportional to the administered dose in rats 34 and in healthy volunteers, up to 24 hrs after cessation of intravenous administration.…”

The influence of myeloid‐derived suppressor cells on angiogenesis and tumor growth after cancer surgery

“…Following a major surgery, cellular immunity remains suppressed for several days with decrease in circulating levels of cytotoxic T lymphocytes (CTLs), natural killer (NK) cells, dendritic cells (DCs) and T‐helper cells . The magnitude of this immune suppression is proportional to the degree of surgical manipulation . Therefore, the immediate postoperative period may contribute substantially to the risk of subsequent emergence of metastasis, and perioperative modulations that reduce this risk may improve long‐term outcome .…”

The effect of analgesia with omnopon and dexketoprofen on the endocytic activity of phagocytes of different localization on the surgical tumor resection model

“…Хірургічне видалення пухлини є основним терапевтичним підходом первинного лікування більшості нозологічних форм раку. Клінічні та експериментальні дослідження останніх 10 років встановили, що хірургічні стресові фактори, такі як пошкодження тканин, крововтрата, біль, а також анестезіологічні препарати чинять негативний вплив на імунну систему пацієнта, створюючи тим самим сприятливі умови для уникнення пухлинними клітинами імунного нагляду [1,2]. Крім того, післяопераційне запалення є одним із важливих чинників системного поширення пухлини [3].…”