Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre.
Centre for Integrated Critical Care Medicine, The University of Melbourne.
Curr Opin Anaesthesiol. 2021 Jun 1;34(3):317-325. doi: 10.1097/ACO.0000000000001002.
Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes.
To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research.
The biologic perturbation of the perioperative period, compounded by the effects of anesthetic agents, renders patients with cancer particularly vulnerable to enhanced viability of minimal residual disease, with long-term outcome consequences. However, low level and often conflicting clinical evidence equipoise currently exists with regards to optimal oncoanesthesia techniques. Large, prospective, randomized control trials are urgently needed to inform evidence-based clinical practice guidelines.
手术仍然是治疗实体瘤的重要手段。然而，手术应激反应会导致肾上腺素能、炎症和免疫系统的生理紊乱，从而可能促进致癌途径。麻醉技术本身可能会减弱/增强这些途径，并因此可能与长期的癌症结果有关。
迄今为止，临床研究主要是回顾性的且研究力度不足，因此限制了得出有意义的结论。最近，对乳腺癌和结直肠癌手术的区域麻醉进行的前瞻性研究未能显示出长期的癌症结果获益。然而，基于对手术应激和挥发性麻醉在临床前研究中促肿瘤作用的一致观察，以及体内肿瘤进展和转移模型的支持，我们正在等待强有力的探索依托咪酯为基础的全静脉麻醉（与吸入性挥发性药物相比）在肿瘤进展中的作用的前瞻性临床研究。此外，抗肾上腺素能/抗炎辅助药物，如利多卡因、非甾体抗炎药和抗肾上腺素能普萘洛尔，值得进一步研究。
围手术期的生物学干扰，加上麻醉药物的作用，使癌症患者特别容易受到微小残留疾病活力增强的影响，从而导致长期后果。然而，关于最佳肿瘤麻醉技术目前仍然存在低水平且常常相互矛盾的临床证据。迫切需要进行大型、前瞻性、随机对照试验，为循证临床实践指南提供信息。
