Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.31
Revised: January 27, 2014
Accepted: February 16, 2014
Published online: March 27, 2014
Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatment for most malignant tumors. However, surgery itself can inhibit important host defenses and promote the development of metastases. An altered balance between the metastatic potential of the tumor and the anti-metastatic host defenses, including cell-mediated immunity and natural killer cell function, is a plausible mechanism of increased cancer metastasis. This article reviews the increasingly recognized concept of anesthetic technique along with perioperative factors and their potential to affect long-term outcome after cancer surgery. The potential effect of intravenous anesthetics, volatile agents, local anesthetic drugs, opiates, and non-steroidal anti-inflammatory drugs are reviewed along with recent literature and ongoing clinical trials in this area. Regional anesthesia is increasingly emerging as a safer option with less cancer recurrence potential as compared to general anesthesia. Blood transfusion, pain, stress, use of beta-blockers, and hypothermia are other potentially important perioperative factors to consider.
Core tip: Cancer mortality is frequently related to metastatic disease. An altered balance between the tendency of the tumor to spread via metastasis and the body’s anti defense processes is the most plausible mechanism of cancer spread. This comprehensive review summarizes the role of anesthetic technique and perioperative interventions and their influence in cancer recurrence. An exhaustive compilation of the latest research and ongoing clinical trials in this area is presented to the reader.