Sekandarzad Mir W, van Zundert André A J, Doornebal Chris W, Hollmann Markus W
aDepartment of Anaesthesia, Logan Hospital, Meadowbrook bDepartment of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women's Hospital, The University of Queensland, Brisbane, Queensland, Australia cDepartment of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
Curr Opin Anaesthesiol. 2017 Oct;30(5):606-612. doi: 10.1097/ACO.0000000000000492.
There is ongoing controversy regarding the tumor-protective effects of regional anesthesia in patients undergoing cancer surgery. Evidence of up-to-date systematic reviews will be presented alongside recent updates on the effects of opioids and local anesthetics.
In recent years, the literature regarding the effects of regional anesthesia techniques on cancer recurrence has raised many unanswered questions. Ongoing randomized controlled trials may not be able to shed light on the controversial discussion regarding the tumor protective effects of regional anesthesia because the expected effect size and event rate in those studies may be overstated.Recent more refined animal data, provides no evidence to suggest that opioids promote cancer recurrence or facilitate the development of metastatic disease.In addition, local anesthetics have promising preclinical anticarcinogenic effects that extend beyond their voltage-gated sodium channel blocking properties and could be of therapeutic value.
Cancer recurrence in patients undergoing surgery remains a global burden. Current evidence suggests that regional techniques, opioid analgesia and local anesthetics in onco-anesthesia may require a tailored individual approach due to the phenotypic and genotypic heterogeneity within and between different tumors. The authors surmise that future or ongoing randomized controlled trials regarding regional anesthesia techniques and cancer outcome may not be able to reproduce clear results, as it will be challenging to prove the efficacy of one single intervention (e.g. regional anesthesia) in an otherwise complex multifactorial perioperative oncological setting.
对于癌症手术患者，区域麻醉的肿瘤保护作用一直存在争议。将展示最新系统评价的证据以及关于阿片类药物和局部麻醉药作用的近期更新内容。
近年来，关于区域麻醉技术对癌症复发影响的文献提出了许多未解决的问题。正在进行的随机对照试验可能无法阐明关于区域麻醉肿瘤保护作用的争议性讨论，因为这些研究中的预期效应大小和事件发生率可能被高估。最近更精细的动物数据没有提供证据表明阿片类药物会促进癌症复发或促进转移性疾病的发展。此外，局部麻醉药具有有前景的临床前抗癌作用，其作用超出了它们对电压门控钠通道的阻断特性，可能具有治疗价值。
手术患者的癌症复发仍然是一个全球性负担。目前的证据表明，由于不同肿瘤内部和之间的表型和基因型异质性，肿瘤麻醉中的区域技术、阿片类镇痛和局部麻醉药可能需要采用量身定制的个体化方法。作者推测，未来或正在进行的关于区域麻醉技术与癌症结局的随机对照试验可能无法得出明确结果，因为在复杂的多因素围手术期肿瘤学环境中证明单一干预措施（如区域麻醉）的疗效将具有挑战性。
