Erschienen in:
01.12.2018 | Cancer Anesthesia (B Riedel and V Gottumukkala, Section
Editors)
The Effect of Anaesthetic and Analgesic Technique on Oncological
Outcomes
verfasst von:
Aislinn Sherwin, Donal J. Buggy
Erschienen in:
Current Anesthesiology Reports
|
Ausgabe 4/2018
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Abstract
Purpose of Review
The purpose of this review is to provide an examination of the
recent literature relating to anaesthesia and analgesia for cancer surgery and
their potential effects on cancer recurrence and metastasis.
Recent Findings
Opioids continue to have mixed results in terms of their long-term
effects on cancer outcomes. While laboratory evidence suggests alterations in
immune responses and pro-tumourigenic effects via opioid receptors on cancer
cells, clinical evidence is lacking. Regional anaesthesia has the ability to
regulate surgical stress response, but retrospective studies provide conflicting
results. However, lidocaine appears to have protective functions against cancer
and anti-inflammatory properties making it a potentially useful agent
perioperatively. An association also exists between the use of non-steroidal
anti-inflammatory agents and improved perioperative outcomes; however,
prospective clinical studies are required to provide more robust data in this
area. Inhalational agents appear to confer increased risk of cancer recurrence
in comparison to total intravenous anaesthesia (TIVA). A recent large
retrospective trial and in vivo and in vitro evidence point to a beneficial
effect of TIVA versus volatiles that should be fully investigated.
Summary
Retrospective analysis provides tenuous links between the techniques
used perioperatively and potential cancer recurrence and metastasis. In vitro
and in vivo animal studies have furthered research in the area, particularly
providing mechanisms on how commonly used agents can affect patient outcomes.
However, large prospective randomised control trials are required in this area
to further the research on anaesthesia and its effects on cancer recurrence and
metastasis.