Consensus statement from the BJA Workshop on Cancer and Anaesthesia

Buggy, Donal J.; Borgeat, A.; Cata, Juan P.; Doherty, Derek G.; Doornebal, Chris W.; Forget, Patrice; Gottumukkala, Vijay; Gottschalk, André; Gupta, Arjun; Gupta, Kim; Hales, Tim G.; Hemmings, Hugh C.; Hollmann, Markus W.; Kurz, Andrea; Ma, Daqing; Parat, Marie-Odile; Sessler, Daniel I.; Shorten, G.; Singleton, P.

doi:10.1093/bja/aeu262

Cited by 82 publications

(53 citation statements)

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“…7 The recent ''Consensus statement from the BJA Workshop on Cancer and Anaesthesia'' acknowledges insufficient evidence to support a change in clinical practice and calls for further research, preferably in the form of RCTs, to investigate the effects of volatile agents, opioids, nonsteroidal anti-inflammatory drugs (NSAIDS), and regional anesthetic techniques on cancer recurrence and metastasis. 9 Indeed, although the evidence is inconclusive, the possibility that anesthesia may contribute to the recurrence of cancer cannot be ignored and requires definitive prospective RCTs to test whether a link of cause and effect exists between the most promising perioperative interventions and the risk of recurrence.…”

Section: Résumémentioning

confidence: 99%

Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?

Byrne

Levins

Buggy

2015

Can J Anesth/J Can Anesth

128

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Section: Résumémentioning

confidence: 99%

Can anesthetic-analgesic technique during primary cancer surgery affect recurrence or metastasis?

Byrne

Levins

Buggy

2015

Can J Anesth/J Can Anesth

128

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“…This viewpoint is supported by a recent consensus statement expressing concern that experimental evidence suggests a link between anaesthestic technique and cancer recurrence yet accepts that there is insufficient clinical evidence to justify any change in practice and calls for the conduct of definitive randomised clinical trials [35].…”

Section: Anaesthesia Analgesics and The Inflammatory Responsementioning

confidence: 99%

The perioperative immune response

O’Dwyer

Owen

Torrance

2015

Current Opinion in Critical Care

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Purpose of ReviewA host of immune modulators are now available in clinical practice. The perioperative period is characterised by profound alterations in host immunity, which can result in poor outcomes, which include infection, cancer recurrence and organ failure. Manipulation of the peri-operative immune response has the potential to improve outcomes. A complete understanding of the mechanisms and clinical consequences of altered immune function in this setting is therefore imperative. Recent findingsRecent in vivo data has emerged which furthers our understanding of the interaction between tissue damage, immune modulation and clinical outcomes by utilising novel laboratory techniques capable of monitoring single cell immune signatures. Traditional gene expression assays have continued to demonstrate their utility and have been instrumental in defining the host response to perioperative allogeneic blood transfusion. These mechanistic studies are complemented by large clinical studies describing associations between anaesthetic modalities and immune-related outcomes. SummaryLaboratory techniques are now available that can monitor the perioperative immune response and could be further developed to introduce personalised care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that, whilst not immediately harmful, may be associated with poor outcomes temporally distant from the treatment, secondary to induced immunosuppression.3

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“…2 Preclinical laboratory research suggests that both GA and narcotics increase patient tumor immunosuppression and stimulate cancer growth. [3][4][5][6][7][8][9][10] Whether these basic scientific findings correlate with increased breast cancer recurrence is unproven; yet, a single clinical breast cancer study by Exadaktylos et al 11 in 2006 concluded that paravertebral block (PVB) , as an adjunct to GA, was associated with a remarkable 4-fold reduction in breast cancer recurrence compared with GA alone. Follow-up studies from these investigators demonstrated that patient proinflammatory cytokine profiles were more favorable for cancer immune competence in patients receiving regional anesthesia, presumably because of attenuation of the neuroendocrine stress response to surgery.…”

mentioning

confidence: 99%