ANAESTHESIA AND CANCER RECURRENCE

OBJECTIVE:

To discuss about impact of anaesthetic technique upon outcome in oncological surgery

LEARNING POINTS

• still insufficient evidence to suggest the usage of specific anaesthetic agents to reduce the risk of cancer recurrence in patients who undergo cancer surgery
• pre-operative period associated with multiple factors that may influence tumor cell survival, including inflammatory and stress response to surgery, relative immunosuppression and possible direct effects of anaesthetics, opioids.
• most existing clinical studies are retrospective or were initially designed to study outcomes rather than cancer recurrence. 
• volatile anaesthetics have pro inflammatory effects , and may have direct and indirect effect on cancer cell survival
• propofol may have anti-inflammatory and anti-oxidative effects that protect against immune suppression and may preserve natural killer (NK) cell activity.
• regional anaesthesia could reduce cancer recurrence by reducing the need for opioids or volatile or reducing stress response to surgery. But, there is no high quality clinical evidence.

DISCUSSION:

• preoperative factors such as surgical stress response, inflammatory response to surgery and direct effect of anaesthetic and opioids combine to create a relative state of immunosuppression at a time when tumor may be disseminated
• propofol exhibit anti tumor effect due to its anti-inflammatory and anti-oxidative effect which may protect against peri-operative immune suppression
• peri-operative NSAIDS/ COX-2 inhibitor has potential benefit in cancer progression beside its opioids sparing effect
• both tissue hyperoxia and hypoxia may facilitate tumor progression

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