Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis?
Affiliation
Department of Anaesthesia, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland.Issue Date
2012-12
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Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? 2012, 109 Suppl 1:i17-i28 Br J AnaesthJournal
British journal of anaesthesiaDOI
10.1093/bja/aes421PubMed ID
23242747Abstract
Summary Cancer is a leading cause of morbidity and mortality worldwide and the ratio of incidence is increasing. Mortality usually results from recurrence or metastases. Surgical removal of the primary tumour is the mainstay of treatment, but this is associated with inadvertent dispersal of neoplastic cells into the blood and lymphatic systems. The fate of the dispersed cells depends on the balance of perioperative factors promoting tumour survival and growth (including surgery per se, many anaesthetics per se, acute postoperative pain, and opioid analgesics) together with the perioperative immune status of the patient. Available evidence from experimental cell culture and live animal data on these factors are summarized, together with clinical evidence from retrospective studies. Taken together, current data are sufficient only to generate a hypothesis that an anaesthetic technique during primary cancer surgery could affect recurrence or metastases, but a causal link can only be proved by prospective, randomized, clinical trials. Many are ongoing, but definitive results might not emerge for a further 5 yr or longer. Meanwhile, there is no hard evidence to support altering anaesthetic technique in cancer patients, pending the outcome of the ongoing clinical trials.Item Type
ArticleLanguage
enISSN
1471-6771ae974a485f413a2113503eed53cd6c53
10.1093/bja/aes421
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