Perry Nicholas J S, Jhanji Shaman, Poulogiannis George
From the Signalling & Cancer Metabolism Team, Division of Cancer Biology, The Institute of Cancer Research, London, UK.
Department of Anaesthesia, Perioperative Medicine and Critical Care, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
Anesth Analg. 2025 Apr 1;140(4):846-859. doi: 10.1213/ANE.0000000000007328. Epub 2024 Dec 17.
Efforts to deconvolve the complex interactions of cancer cells with other components of the tumor micro- and macro-environment have exposed a common tendency for cancers to subvert systems physiology and exploit endogenous programs involved in homeostatic control of metabolism, immunity, regeneration, and repair. Many such programs are engaged in the healing response to surgery which, together with other abrupt biochemical changes in the perioperative period, provide an opportunity for the macroevolution of residual disease. This review relates contemporary perspectives of cancer as a systemic disease with the overlapping biology of host responses to surgery and events within the perioperative period. With a particular focus on examples of cancer cell plasticity and changes within the host, we explore how perioperative inflammation and acute metabolic, neuroendocrine, and immune dyshomeostasis might contribute to cancer evolution within this contextually short, yet crucially influential timeframe, and highlight potential therapeutic opportunities within to further optimize surgical cancer care and its long-term oncological outcomes.
解析癌细胞与肿瘤微环境和宏观环境其他成分之间复杂相互作用的努力揭示了癌症的一个共同趋势，即颠覆系统生理学并利用参与新陈代谢、免疫、再生和修复稳态控制的内源性程序。许多此类程序参与了对手术的愈合反应，而手术愈合反应与围手术期的其他突然生化变化一起，为残留疾病的宏观进化提供了机会。本综述将癌症作为一种全身性疾病的当代观点与宿主对手术的反应以及围手术期事件的重叠生物学联系起来。特别关注癌细胞可塑性和宿主内变化的例子，我们探讨围手术期炎症以及急性代谢、神经内分泌和免疫稳态失调如何在这个背景下虽短但至关重要的影响时间范围内促进癌症进化，并强调其中潜在的治疗机会，以进一步优化外科癌症护理及其长期肿瘤学结果。
