Department of Surgical Oncology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Parkville 3010, Victoria, Australia.
Faculty of Medicine, Dentistry and Health Sciences, Building 181, University of Melbourne, Grattan Street, Parkville 3010, Victoria, Australia.
Nat Rev Clin Oncol. 2018 Apr;15(4):205-218. doi: 10.1038/nrclinonc.2017.194. Epub 2017 Dec 28.
Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.
手术是治疗实体瘤患者的主要方法。然而，尽管有根治性手术切除和（新）辅助治疗效果的诸多进展，转移性疾病仍然很常见，且死亡率很高。手术应激反应伴随的生物学改变和麻醉药物的药理作用，反而可能促进疾病复发或转移性疾病的进展。当手术后癌细胞在局部或未诊断的远处部位持续存在时，手术和/或麻醉激活的神经内分泌、免疫和代谢途径可能促进其存活和增殖。这种效应的结果是，微小残留疾病可能会失去平衡并进展为转移性疾病。在此，我们讨论了最有前途的围手术期护理改进方案，以应对这些挑战。我们概述了麻醉技术调整的基本原理和初步证据，以及抗肾上腺素能、抗炎和/或抗血栓治疗的策略性应用。这些策略中的许多目前正在大型队列试验中进行评估，并有望成为负担得起、易于获得的干预措施，改善癌症患者的术后无复发生存率。
