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Can anesthetic techniques or drugs affect cancer recurrence in patients undergoing cancer surgery?

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Abstract

Despite the development of effective chemotherapy and radiotherapy, surgery remains the mainstay treatment of many cancers, requiring anesthesia. Almost all cancer deaths after primary surgery are attributable to recurrence or metastases. Recently it has been hypothesized that the perioperative anesthetic management of cancer patients could potentially affect the risk of recurrence and metastases, which implies a key role for anesthesiologists in choosing anesthetic agents and techniques that optimize the balance between the metastatic potential of the tumor versus its elimination by antimetastatic immune defenses. This review summarizes available experimental information on the potential effects of common anesthetic agents and techniques on cancer metastases and the conflicting retrospective clinical data on regional anesthesia in various types of cancer. A number of prospective, randomized, multicenter, clinical trials are in progress, and their results are eagerly awaited.

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Acknowledgments

The subject of this review encompasses a large literature base, and we apologize to those authors whose work we could not cite for reason of space limitations. Work on opioids in the University of Leicester is funded by HOPE Foundation for Cancer Research (http://www.hfcr.org) and the British Journal of Anaesthesia/Royal College of Anaesthetists. Professors Lambert and Rowbotham have collaborative links with University of Ferrara Peptides (UFPeptides), which is involved in the development of opioid ligands. Professor D.G. Lambert holds a consultancy with Grunenthal GmbH. The research of Professor Buggy in this area is supported by The Sisk Foundation, Dublin, Ireland.

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Authors and Affiliations

  1. Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Aomori, Japan

    Hidetomo Niwa

  2. Department of Health Sciences, University of Leicester, Division of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    David J. Rowbotham

  3. Department of Cardiovascular Sciences, University of Leicester, Division of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    David G. Lambert

  4. Division of Anaesthesia, Intensive Care and Pain Medicine, Mater Misericordiae University Hospital and National Cancer Screening Service Eccles Unit, Dublin, Ireland

    Donal J. Buggy

  5. Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA

    Donal J. Buggy

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  1. Hidetomo Niwa
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  2. David J. Rowbotham
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  3. David G. Lambert
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  4. Donal J. Buggy
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Correspondence to David G. Lambert.

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Niwa, H., Rowbotham, D.J., Lambert, D.G. et al. Can anesthetic techniques or drugs affect cancer recurrence in patients undergoing cancer surgery?. J Anesth 27, 731–741 (2013). https://doi.org/10.1007/s00540-013-1615-7

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  • DOI: https://doi.org/10.1007/s00540-013-1615-7

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