The Impact of Perioperative Events on Cancer Recurrence and Metastasis in Patients after Radical Gastrectomy: A Review

Abstract

Radical gastrectomy is a mainstay therapy for patients with locally resectable gastric cancer (GC). GC patients who are candidates for radical gastrectomy will experience at least part of the following perioperative events: surgery, anesthesia, pain, intraoperative blood loss, allogeneic blood transfusion, postoperative complications, and their related anxiety, depression and stress response. Considerable clinical studies have shown that these perioperative events can promote recurrence and decrease the long-term survival of GC patients. The mechanisms include activation of neural signaling and the inflammatory response, suppression of antimetastatic immunity, increased release of cancer cells into circulation, and delayed adjuvant therapy, which are involved in every step of the invasion-metastasis cascade. Having appreciated these perioperative events and their influence on the risk of GC recurrence, we can now use this knowledge to find strategies that might substantially prevent the deleterious recurrence-promoting effects of perioperative events, potentially increasing cancer-free survival in GC patients.

Harnessing interventions during the immediate perioperative period to improve the long-term survival of patients following radical gastrectomy

“…In clinical settings, extensive surgery for GC always provides no additional survival benefits and even leads to poor survival in some patients[ 6 , 7 ]. Other necessary events during the perioperative period, including anesthesia and analgesia, can shorten the long-term survival of patients with GC if the modality or agents are administered inappropriately[ 8 ]. Adverse events during gastrectomy or postoperative recovery, such as intraoperative blood loss, allogeneic blood transfusion, and POCs, were all proven to be independent negative prognostic factors for patients following curative gastrectomy[ 8 ].…”

“…Other necessary events during the perioperative period, including anesthesia and analgesia, can shorten the long-term survival of patients with GC if the modality or agents are administered inappropriately[ 8 ]. Adverse events during gastrectomy or postoperative recovery, such as intraoperative blood loss, allogeneic blood transfusion, and POCs, were all proven to be independent negative prognostic factors for patients following curative gastrectomy[ 8 ]. In addition, concomitant anxiety, depression and stress response can aggravate the cancer-promoting effects of gastrectomy and its related events.…”

“…The perioperative physiological responses that underpin the cancer-promoting effects of radical surgery and its related events have been extensively studied in surgical oncology and have been excellently reviewed in previous publications[ 5 ]. Conclusions relevant to GC have also been discussed in our previous review[ 8 ]. Briefly, gastrectomy and its related events activate the sympathetic nervous system (SNS) and inflammatory response, also referred to as the surgical stress response, leading to enhanced growth of residual cancer cells, which may be preexisting micrometastases, incompletely resected fractions of tumor cells or disseminated from the primary tumor during the operation.…”

“…Nevertheless, both minimally invasive and traditional surgical approaches for GC are highly technically demanding, with a high incidence of intraoperative blood loss and POCs in less experienced hands. Numerous data support the negative effects of intraoperative blood loss, transfusion and POCs on prognosis in patients following radical gastrectomy[ 8 ]. In addition, the inferior short-term and long-term outcomes following radical gastrectomy in the East compared with the West were not only determined by more advanced stage and comorbidities but also by the low incidence of GC and uncommon regional specialization.…”

Effect of regional block technique on postoperative high-grade complications according to Clavien-Dindo classification in elderly patients with thoracic and abdominal cancer: a retrospective propensity score matching analysis

“…The postoperative outcome of cancer patients is often the focus of attention. Different anesthesia methods can affect the postoperative outcome of cancer patients ( 1 ).Poorly controlled perioperative pain has been shown to associate with increased morbidity, impaired quality of life, longer hospital stays, more opioid use, and higher healthcare costs ( 2 ). Systemic opioid analgesics has been used to provide relief from severe trauma-related pain but their use is hampered by serious risks such as respiratory depression, opioid-use disorder, and potentially fatal overdose ( 3 ).…”