The Role of the Perioperative Period in Recurrence After Cancer Surgery

Abstract

A wealth of basic science data supports the hypothesis that the surgical stress response increases the likelihood of cancer dissemination and metastasis during and after cancer surgery. Anesthetic management of the cancer patient, therefore, could potentially influence long-term outcome. Preclinical data suggest that beneficial approaches might include selection of induction drugs such as propofol, minimizing the use of volatile anesthetics, and coadministration of cyclooxygenase antagonists with systemic opioids. Retrospective clinical trials suggest that the addition of regional anesthesia might decrease recurrence after cancer surgery. Other factors such as blood transfusion, temperature regulation, and statin administration may also affect long-term outcome.

NSAID analgesic ketorolac used perioperatively may suppress early breast cancer relapse: particular relevance to triple negative subgroup

“…Published along with the original Forget et al study, an outline of a number of possible effects of surgery and anesthesia on cancer growth was presented by Gottschalk et al [4]. These include stress, immunosuppression, pain, fig.…”

The Effects of Epidural Anaesthesia and Analgesia on Natural Killer Cell Cytotoxicity and Cytokine Response in Patients with Epithelial Ovarian Cancer Undergoing Radical Resection

“…32 In contrast, both IL-10 and IFN-γ are well known antitumour cytokines. 33,34 IL-10 exhibits antitumour and antimetastatic activity through enhanced NK cell lysis of tumour cells. 35 IFN-γ has important effects in the tumour microenvironment, including the inhibition of cell proliferation and angiogenesis.…”

Nonintubated Videothoracoscopic Operations in Thoracic Oncology

“…In this regard, it is well known that both surgical manipulations and general anesthesia may interfere with tumor growth through diverse mechanisms. First, surgical stress and postoperative pain themselves may accelerate escape of occult tumor foci from their dormancy condition, thus promoting both local and distant recurrences [27,28]. This association has been proven to occur in both human and animal settings, and is mainly attributed to postsurgical suppression of immunosurveillance against tumor cells.…”

“…Some factors related to general anesthesia itself are also believed to interfere with postsurgical tumor progression [27,28]. For example, opioids seems to have a role in immune suppression, even though existing data in this regard are quite controversial.…”