Hirai Toshihiro, Matsumoto Hideo, Kubota Hisako, Yamaguchi Yoshiyuki
Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan,
Surg Today. 2014 May;44(5):804-11. doi: 10.1007/s00595-013-0627-0. Epub 2013 Jun 5.
Excessive surgical stress and postoperative complications cause a storm of perioperative cytokine release, which has been shown to enhance tumor metastasis in experimental models. We have named this phenomenon "surgical oncotaxis". The mechanisms that underpin this process are thought to be excessive corticosteroid secretion, coagulopathy in the peripheral vasculature, immune suppression and excessive production of reactive oxygen species. Nuclear factor-kappa B (NFkB) activation plays a key role in these mechanisms. Minimally invasive surgical techniques should be used, and postoperative complications should be avoided whenever possible to lessen the impact of surgical oncotaxis. Furthermore, there may be a role for a small preoperative dose of corticosteroid or the use of free radical scavengers in the perioperative period. Recently, there has been a great deal of interest in omega-3 fatty acid, because it regulates NFkB activation. The use of multimodal treatments that regulate surgical oncotaxis may be as important as chemotherapy for determining the outcome of patients with cancer undergoing surgery.
过度的手术应激和术后并发症会引发围手术期细胞因子释放风暴，实验模型已表明这会增强肿瘤转移。我们将此现象命名为“手术肿瘤趋向性”。该过程的潜在机制被认为是皮质类固醇分泌过多、外周血管系统的凝血功能障碍、免疫抑制以及活性氧的过度产生。核因子-κB（NFkB）激活在这些机制中起关键作用。应采用微创手术技术，并尽可能避免术后并发症，以减轻手术肿瘤趋向性的影响。此外，术前小剂量使用皮质类固醇或在围手术期使用自由基清除剂可能会发挥作用。最近，ω-3脂肪酸备受关注，因为它能调节NFkB激活。对于接受手术的癌症患者，采用调节手术肿瘤趋向性的多模式治疗可能与化疗一样，对决定患者预后至关重要。
