Review
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World J Anesthesiol. Mar 27, 2014; 3(1): 31-45
Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.31
Perioperative care and cancer recurrence: Is there a connection?
Ashish K Khanna, Efrain Riveros Perez, Krzysztof Laudanski, Amanda Moraska, Kenneth C Cummings III
Ashish K Khanna, Efrain Riveros Perez, Amanda Moraska, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Krzysztof Laudanski, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, United States
Kenneth C Cummings III, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Khanna AK contributed to the design, initial organization and acquisition of data, formatting and final approval of the drafted manuscript; Perez ER, Laudanski K and Moraska A contributed to the acquisition of data, formatting and write up of the drafted manuscript; Cummings KC III contributed to the design, initial organization and acquisition of data, formatting and final approval of the drafted manuscript.
Correspondence to: Kenneth C Cummings III, MD, MS, Staff Anesthesiologist, Anesthesiology Institute, Cleveland Clinic Foundation, 9500, Euclid Avenue, E-30, Cleveland, OH 44195, United States. cummink2@ccf.org
Telephone: +1-216-4441016 Fax: +1-216-4444383
Received: October 21, 2013
Revised: January 27, 2014
Accepted: February 16, 2014
Published online: March 27, 2014
Abstract

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.

Keywords: Cancer, Recurrence, Survival, Anesthesia, Perioperative, Factors

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.