Cancer surgery: risks and opportunities

Abstract

In the recent past, several papers have pointed to the possibility that tumour removal generates a permissive environment in which tumour growth is potentiated. This phenomenon has been coined "perioperative tumour growth" and whilst it represents a departure in terms of our attitude to the surgical process, this concept was first hinted at by Paget(1) himself. Despite this, the time interval immediately before and after cancer surgery (i.e. the perioperative period) remains an underutilised interval during which chemotherapeutic regimens are rarely implemented. Herein, we present a summarised review of the literature that supports the concept that tumour removal may potentiate the growth of residual neoplastic disease. We also outline current knowledge regarding underlying mechanisms and in this manner highlight potential therapeutic entry points. Finally, we emphasise the urgent need for trials of agents that could protect patients against the harmful host-tumour interactions that may occur during the perioperative period.

A Prospective Case-Control Study of the Local and Systemic Cytokine Response After Laparoscopic Versus Open Colonic Surgery

“…In addition, local peritoneal cytokines also have a specific role to play in postoperative ileus [22][23][24][25][26], the formation of peritoneal adhesions [27][28][29][30][31][32], and tumor promotion [33][34][35][36][37]. Only two studies identified in the meta-analysis above measured levels of local peritoneal humoral factors, and their results were conflicting.…”

The Humoral Response After Laparoscopic Versus Open Colorectal Surgery: A Meta-Analysis

“…During and after surgery for neoplasia, cells exfoliated from the primary lesion (or leaked out of lymphatics) can bind to the endothelium and mesothelium facilitated by interactions between ligands induced by epidermal growth factor, interleukin 1b, and other humoral factors [28,29]. Peritoneal disruption during surgery dramatically increases levels of these local mediators, leading to a tumor promoting effect that is not restricted to the inflicted site but rather has a generalized character, promoting tumor growth in non-traumatised, as well as traumatised peritoneum [29,30].…”

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

“…Additionally, blood samples were taken via a cardiac puncture, and centrifuged for 5 minutes at 300 g. Plasma samples were collected and stored at -80°C for further analysis. Alternatively, for long-term experiments, 2 × 10 5 CC531s tumor cells were injected through the catheter. Animals were sacrificed 14 days after tumor cell injection (n = 12/group).…”

“…Macrophages were harvested by 15 minutes incubation with trypsin-EDTA and subsequent scraping with a cell scraper. Macrophages were seeded in black clear-bottom 96-well plates (1 × 10 5 cells/well).…”

“…5-7 There is no consensus yet on whether laparoscopic colectomy is superior to open approach with respect to oncological outcome of cancer patients, and conflicting data has been described. In one study it was reported that patients undergoing conventional open colectomy for removal of the colorectal tumor had poor long-term cancer related survival compared to patients undergoing laparoscopy-assisted surgery.…”