L’anesthésie, l’analgésie et la modulation sympathique augmentent-elles l’incidence des récidives néoplasiques après chirurgie ? Une revue de la littérature centrée sur la modulation de l’activité des lymphocytes natural killer

Hypnosis in the Perioperative Management of Breast Cancer Surgery: Clinical Benefits and Potential Implications

“…Surgical removal of the primary tumor is the main treatment option for most cancers, but the perioperative period is a critical time for cancer evolution [3, 7, 59, 60]. Indeed, both surgical and medical factors play a role.…”

“…Surgical factors identified in human studies are related to tumor manipulation and tissue attrition, increasing shedding of malignant cells into the circulation, potentiating invasion of free malignant cells (mediated by matrix metalloproteinases and adhesion molecules), favoring a proangiogenic switch in micrometastases (VEGF), and increasing levels of growth factors (EGF) caused by tissue damage, and this encouraging local and distant recurrence [59, 60]. …”

“…Endogenous factors involve neuroendocrine (hypothalamic-pituitary-adrenal axis) and nervous system (nociceptive pathways and sympathetic system) loops [59]. Both perioperative psychological stress [60] and tissue injury [5] trigger numerous metabolic and hormonal changes, resulting in a “stress response” involving sympathetic, endocrine, and immunological effects.…”

“…Stress hormones, specifically catecholamines, opioids, and glucocorticoids, were shown in animal models to causally promote metastatic progression (immunological and nonimmunological mechanisms) [60]. Moreover, during the perioperative period, natural killer (NK) cells, a component of the immune system, are particularly vulnerable, and the decline in their cytotoxic activity potentially exposes patients to increased oncological risk [59, 61]. In rats, stress caused by release of catecholamines was found to impair NK cell activity [62] and could therefore influence tumor progression [63].…”

“…Among exogenous factors, anesthesia and analgesic medications (e.g., opioids, nonsteroidal anti-inflammatory drugs (NSAIDs)) act directly and indirectly on immune cells [3, 59, 60, 64] and can potentially impact cancer recurrence or metastasis [3, 65, 66]. Morphine and its derivatives appear to depress NK cell activity in animal and human studies [59], while NSAIDs were shown to decrease the risk of BC in a retrospective human analysis [67].…”