Adrenergic, Inflammatory, and Immune Function in the Setting of Oncological Surgery

Duff, Stephen; Connolly, Cara; Buggy, Donal J.

doi:10.1097/aia.0000000000000120

Cited by 22 publications

(9 citation statements)

References 53 publications

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“…In terms of cancer recurrence, regional blockade may offer some benefits: (1) reduction of the stress response may reduce associated immunosuppression [44], (2) pain reduction may reduce opioid use and thus the possible adverse effects of opioids on cancer recurrence [45], and (3) amide local anesthetics may have direct antitumor effects [46,47].…”

Section: Effect Of Regional Blockade On Cancer Recurrence and Patient...mentioning

confidence: 99%

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review

Chai

Wang

et al. 2022

Pain Ther

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Breast surgery, especially radical mastectomy, is often accompanied by moderate to severe acute pain, which significantly reduces postoperative quality of life. Effective pain management can accelerate patient recovery. Serratus anterior plane block (SAPB) is a new type of fascial plane block technique, which can better target the nerve network innervating the chest wall and breast and provide good analgesia in the anterolateral chest wall. Current clinical research evidence indicates that SAPB has significant benefits in breast surgery. Further research avenues for this technology include optimal local anesthetic dosing strategy, the type of SAPB which is more suitable for breast surgery, comparison of SAPB and pectoral nerve block II (PECS II) in breast surgery, and high-quality randomized controlled study with outcomes of chronic pain or cancer prognosis.

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Section: Effect Of Regional Blockade On Cancer Recurrence and Patient...mentioning

confidence: 99%

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review

Chai

Wang

et al. 2022

Pain Ther

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“…Surgery or anesthesia-induced activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system provides immunosuppression through several soluble factors ( 33 , 53 ). Surgical stress upregulates the concentration of proangiogenic factors, including vascular endothelial growth factor (VEGF), and triggers the release of growth factors that promote local and distant growth of malignant tissue ( 54 , 55 ). Innate immune components such as NK cells play a crucial role in eliminating circulating tumor cells and preventing metastasis ( 56 ), where reduced expression of circulating NK cell phenotypes are associated with tumor progression ( 57 ).…”

Section: Perioperative Factors Associated With Cancer Promotionmentioning

confidence: 99%

Application of Anesthetics in Cancer Patients: Reviewing Current Existing Link With Tumor Recurrence

Liu

Wang

2022

Front. Oncol.

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Surgery remains the most effective cancer treatment, but residual disease in the form of scattered micro-metastases and tumor cells is usually unavoidable. Whether minimal residual disease results in clinical metastases is a function of host defense and tumor survival and growth. The much interesting intersection of anesthesiology and immunology has drawn increasing clinical interest, particularly, the existing concern of the possibility that the perioperative and intraoperative anesthetic care of the surgical oncology patient could meaningfully influence tumor recurrence. This paper examines current data, including recent large clinical trials to determine whether the current level of evidence warrants a change in practice. Available pieces of evidence from clinical studies are particularly limited, largely retrospective, smaller sample size, and often contradictory, causing several questions and providing few answers. Recent randomized controlled clinical trials, including the largest study (NCT00418457), report no difference in cancer recurrence between regional and general anesthesia after potentially curative surgery. Until further evidence strongly implicates anesthesia in future clinical trials, clinicians may continue to choose the optimum anesthetic-analgesic agents and techniques in consultation with their cancer patients, based on their expertise and current best practice.

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“…The ability of some anaesthetic and analgesic agents to modify immune cell numbers and function is supported by laboratory evidence, although definitive clinical evidence of effects on patient outcomes is not confirmed ( 13 , 38 ). Similarly, experimental evidence has accumulated indicating that lidocaine may modulate various cellular components of the immune system ( 31 ).…”

Section: Effects On Immune Cellsmentioning

confidence: 99%

“…intravenous agents such as propofol versus inhalational agents such as sevoflurane) ( 11 , 12 ). There are multiple biologic pathways through which these agents may exert such effects, with modulation of the immune and inflammatory responses, as well as direct effects on cancer cells among the most likely candidates ( 13 ). The following sections will outline the perioperative use of lidocaine and our current understanding of the pathophysiology underlying postoperative cancer recurrence, before summarising recent laboratory, preclinical and clinical studies as well as planned trials examining lidocaine’s influence on cancer biology and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Intravenous Lidocaine and Metastatic Cancer Recurrence - A Narrative Review

Wall

Buggy

2021

Front. Oncol.

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Cancer is a major global health problem and the second leading cause of death worldwide. When detected early, surgery provides a potentially curative intervention for many solid organ tumours. Unfortunately, cancer frequently recurs postoperatively. Evidence from laboratory and retrospective clinical studies suggests that the choice of anaesthetic and analgesic agents used perioperatively may influence the activity of residual cancer cells and thus affect subsequent recurrence risk. The amide local anaesthetic lidocaine has a well-established role in perioperative therapeutics, whether used systemically as an analgesic agent or in the provision of regional anaesthesia. Under laboratory conditions, lidocaine has been shown to inhibit cancer cell behaviour and exerts beneficial effects on components of the inflammatory and immune responses which are known to affect cancer biology. These findings raise the possibility that lidocaine administered perioperatively as a safe and inexpensive intravenous infusion may provide significant benefits in terms of long term cancer outcomes. However, despite the volume of promising laboratory data, robust prospective clinical evidence supporting beneficial anti-cancer effects of perioperative lidocaine treatment is lacking, although trials are planned to address this. This review provides a state of the art summary of the current knowledge base and recent advances regarding perioperative lidocaine therapy, its biological effects and influence on postoperative cancer outcomes.

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Adrenergic, Inflammatory, and Immune Function in the Setting of Oncological Surgery

Cited by 22 publications

References 53 publications

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review

Application of Anesthetics in Cancer Patients: Reviewing Current Existing Link With Tumor Recurrence

Perioperative Intravenous Lidocaine and Metastatic Cancer Recurrence - A Narrative Review

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