Bezu Lucillia, Akçal Öksüz Dilara, Bell Max, Buggy Donal, Diaz-Cambronero Oscar, Enlund Mats, Forget Patrice, Gupta Anil, Hollmann Markus W, Ionescu Daniela, Kirac Iva, Ma Daqing, Mokini Zhirajr, Piegeler Tobias, Pranzitelli Giuseppe, Smith Laura
EuroPeriscope, ESA-IC Onco-Anaesthesiology Research Group, B-1000 Brussels, Belgium.
Département d'Anesthésie, Chirurgie et Interventionnel, Gustave Roussy, 94805 Villejuif, France.
Cancers (Basel). 2024 Jun 22;16(13):2304. doi: 10.3390/cancers16132304.
Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics' impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.
对实体恶性肿瘤而言，手术切除原发肿瘤是最常见的治愈性手段。有力证据表明，尽管手术有有益效果，但它可能通过引发免疫抑制性炎症应激反应而损害免疫监视，并通过刺激微小残留病灶而促使复发。此外，许多因素在癌症手术前后干扰免疫效应器，如营养不良、贫血或后续输血。因此，围手术期在决定肿瘤学结局方面起着关键作用，并且是一个短暂阶段，可通过使用协同的药理学和非药理学方法支持免疫系统，以规避麻醉和手术的有害因素。与此一致的是，越来越多的研究表明，麻醉药物在癌症手术期间或之后可驱动促肿瘤或抗肿瘤信号通路。虽然专注于麻醉剂对癌细胞行为影响的临床前研究颇具说服力，但研究其对生存和复发影响的有限临床试验仍无定论。在此，我们强调癌症手术围手术期出现的主要因素及其对免疫调节和癌症进展的潜在影响。我们还会讨论手术前和手术期间的患者管理，并考虑文献中的最新进展。
