<p>Anesthesia Options and the Recurrence of Cancer: What We Know so Far?</p>

Abstract

Surgery is a critical period in the survival of patients with cancer. While resective surgery of primary tumors has shown to prolong the life of these patients, it can also promote mechanisms associated with metastatic progression. During surgery, patients require general and sometimes local anesthetics that also modulate mechanisms that can favor or reduce metastasis. In this narrative review, we summarized the evidence about the impact of local, regional and general anesthesia on metastatic mechanisms and the survival of patients. The available evidence suggests that cancer recurrence is not significantly impacted by neither regional anesthesia nor volatile or total intravenous anesthesia.

Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review

“…It can reduce the inflammatory response to surgery and thus, cancer recurrence through several mechanisms. Regional anesthesia attenuates the stress response to surgery via pain control or sympathetic blocks, reduces the need for anesthetic agents, and exhibits direct effects by absorption of local anesthetic agents, as described above ( 112 , 113 ). In a prospective study, patients who underwent lung cancer surgery with thoracic epidural anesthesia had significantly lower IL-6 levels in serum and lung epithelial lining fluid ( 114 ).…”

Therapeutic Perspectives for the Perioperative Period in Oral Squamous Cell Carcinoma (OSCC)

“…The problems raised by the clinical tolerance to general anesthesia in OSCC patients can be found elsewhere [46,47]. Besides the different immediate postoperative characteristics induced by the choice of anesthesia [48], specific protocols may change the risk of post-surgical recurrence of cancer, as suggested in various preclinical models (review in Cata et al [45]). The different anesthetics and/or analgesic regimen used in oral surgery can produce direct effects on OSCC cells [49][50][51].…”

“…Surgical cancer patients receive general, sometimes local or regional anesthesia, and analgesia [ 45 ]. General anesthesia typically relies on total intravenous anesthesia (propofol) or volatile inhaled anesthesia (isoflurane).…”

Impact of anesthetics on oncogenic signaling network: a review on propofol and isoflurane

“…The perioperative use of intravenous or volatile anesthetics may modulate the cancer-promoting/ suppressing signaling network and affect the long-term cancer recurrence and disease-free survivability. Several retrospective studies on different cancer types showed a significant advantage of using total intravenous anesthesia over inhalational anesthesia [131]. A prospective study showed that propofol-epidural anesthesia was associated with longer disease-free survival than sevoflurane/opioids in infiltrating bladder cancer patients undergoing radical tumor cystectomy [132].…”