Cancer Management and Research (Feb 2020)
Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence
Abstract
Federico Longhini,1 Andrea Bruni,1 Eugenio Garofalo,1 Rosalba De Sarro,2 Riccardo Memeo,3 Paolo Navalesi,4 Giuseppe Navarra,5 Girolamo Ranieri,6 Giuseppe Currò,7 Michele Ammendola7 1Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, “Magna Graecia” University, Catanzaro, Italy; 2Department of Clinical and Experimental Medicine, Section of Cardiology, G. Martino General Hospital, University of Messina, Messina, Italy; 3Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari 70124, Italy; 4Anesthesia and Intensive Care, University Hospital of Padua; Department of Medicine, University of Padua, Padua, Italy; 5Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, University Hospital of Messina, Messina 98100, Italy; 6Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre, IstitutoTumori “Giovanni Paolo II”, Bari 70124, Italy; 7Department of Health Science, General Surgery Unit, University “Magna Graecia” Medical School, Catanzaro 88100, ItalyCorrespondence: Michele AmmendolaDepartment of Health Science, Digestive Surgery Unit, University of Catanzaro “Magna Graecia” Medical School, Viale Europa – Germaneto, Catanzaro 88100, ItalyTel +39 0961 3647218Email [email protected]: Tumor recurrences or metastases remain a major hurdle in improving overall cancer survival. In the perioperative period, the balance between the ability of the cancer to seed and grow at the metastatic site and the ability of the patient to fight against the tumor (i.e. the host antitumor immunity) may determine the development of clinically evident metastases and influence the patient outcome. Up to 80% of oncological patients receive anesthesia and/or analgesia for diagnostic, therapeutic or palliative interventions. Therefore, anesthesiologists are asked to administer drugs such as opiates and volatile or intravenous anesthetics, which may determine different effects on immunomodulation and cancer recurrence. For instance, some studies suggest that intravenous drugs, such as propofol, may inhibit the host immunity to a lower extent as compared to volatile anesthetics. Similarly, some studies suggest that analgesia assured by local anesthetics may provide a reduction of cancer recurrence rate; whilst on the opposite side, opioids may exert negative consequences in patients undergoing cancer surgery, by interacting with the immune system response via the modulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, or directly through the opioid receptors on the surface of immune cells. In this review, we summarize the main findings on the effects induced by different drugs on immunomodulation and cancer recurrence.Keywords: anesthesia, anesthetic drugs, anesthetic technique, oncologic surgery, immunosuppression, cancer recurrence
