Anaesthesia and cancer recurrence: the influence of perioperative anaesthetic technique on cancer recurrence after surgery

Abstract

Purpose of reviewCancer is a leading cause of death worldwide, and incidence is increasing. Excisional surgery is essential in approximately 70% of solid organ tumours. Emerging research in onco-anaesthesiology suggests that perioperative anaesthetic and analgesic techniques might influence long-term oncologic outcomes.Recent findingsProspective, randomized control trials (RCTs) demonstrate that perioperative regional and neuraxial anaesthetic techniques do not affect cancer recurrence. Ongoing trials are investigating the potential outcome benefits of systemic lidocaine. Retrospective studies indicate improved postoperative oncologic outcomes for certain types of breast cancer with higher intraoperative opioid dosage, nuancing available evidence on the effect of opioids. RCT evidence suggests that propofol has no beneficial effect compared with volatiles on breast cancer recurrence, although it remains unclear whether this applies to other cancer types.SummaryAlthough regional anaesthesia definitively does not affect cancer recurrence, ongoing prospective RCTs with oncological outcomes as primary endpoints are awaited to establish if other anaesthetic or analgesic techniques influence cancer recurrence. Until such trials conclusively identify a causal relationship, insufficient evidence exists to recommend specific anaesthetic or analgesic techniques for tumour resection surgery based on altering the patient's risk of recurrence.

Local anaesthetics and chemotherapeutic agents: a systematic review of preclinical evidence of interactions and cancer biology

“…For example, there is no high-quality evidence that propofol is superior to volatile agents or that epidural use conveys an advantage in terms of overall survival or cancer recurrence. 11 The exception is a large RCT involving women undergoing breast cancer surgery of curative intent. Almost 1600 women were randomly allocated to an active arm (received peritumoral infiltration of the local anaesthetic lidocaine 0.5% up to 4.5 mg kg −1 body weight, 10 min before surgical excision), compared with a control group, who did not receive local anaesthetic infiltration.…”