Deleterious synergistic effects of distress and surgery on cancer metastasis: Abolishment through an integrated perioperative immune-stimulating stress-inflammatory-reducing intervention

Matzner, Pini; Sorski, Liat; Haldar, Rita; Shaashua, Lee; Benbenishty, Amit; Lavon, Hagar; Azan, Yosi; Sandbank, Elad; Melamed, Rivka; Rosenne, Ella; Ben‐Eliyahu, Shamgar

doi:10.1016/j.bbi.2019.03.005

Cited by 19 publications

(16 citation statements)

References 44 publications

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“…Psychological prehabilitation before cancer surgery is suggested to have an impact on the recovery of patients [ 20 ]. Not only quality of life, but also survival and disease recurrence of patients with cancer appears to be affected by pre- and perioperative psychological distress in general [ 21 , 22 , 23 , 24 ]. Recovery protocols such as ERAS set the value on active patient education and engage a patient to be part of the therapy leading to an improved outcome [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

Lederer

Manteufel

Knott

et al. 2022

JCM

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Recent research suggests an impact of psychological distress on postoperative outcomes in orthopedic and neurosurgery. It is widely unknown whether patients’ mood might affect the postoperative outcome and complication rate in colorectal surgery. Over a period of 22 months, a monocentric, observational study among patients undergoing elective colorectal surgery without the creation of an ostomy was conducted. Patients were asked to fill in a standardized multi-dimensional mood questionnaire (MDMQ) preoperatively as well as on the third, sixth, and ninth postoperative days to assess mood, wakefulness, and arousal. The results of 80 patients (51% male, mean age 59 years) were analyzed. Almost half of the patients (58%) developed postoperative complications according to the Clavien–Dindo classification (Grade I 14%, Grade II 30%, Grade III 9%, Grade IV 3%). Patients’ mood increased continually from the preoperative day to the ninth postoperative day. Patients’ wakefulness decreased initially (pre- to third postoperative day) and increased again in the further course. Patients’ arousal decreased pre- to postoperatively. Neither preoperative mood, nor arousal or wakefulness of patients showed a clear association with the development of postoperative complications. In conclusion, preoperative psychological distress measured by MDMQ did not affect the postoperative complication rate of patients undergoing elective colorectal surgery.

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Section: Introductionmentioning

confidence: 99%

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

Lederer

Manteufel

Knott

et al. 2022

JCM

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“…In this regard, it is known that perioperative perturbation in systemic inflammation is associated with transient weakening of cell-mediated anticancer defense, due to inhibition of Th1 lymphocytes activity and other mechanisms. 7 8 9 10 Therefore, surgery-induced perturbation in systemic inflammation—though usually interpreted as a self-limiting phenomenon with marginal practical relevance—may have a role in determining long-term outcomes. 8 9 10 As a matter of fact, excess systemic inflammation after curative-intent surgery is associated with worse survival in diverse oncology setting, including colorectal cancer, 21 gastric cancer, 22 NSCLC, 23 lung sarcomas, 24 breast cancer, and hepatocellular carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammation after Uniport, Multiport, or Hybrid VATS Lobectomy for Lung Cancer

Tacconi

Carlea

Rocca

et al. 2021

Thorac Cardiovasc Surg

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Background Different video-assisted thoracic surgery (VATS) approaches can be adopted to perform lobectomy for non-small cell lung cancer. Given the hypothetical link existing between postoperative inflammation and long-term outcomes, we compared the dynamics of systemic inflammation markers after VATS lobectomy performed with uniportal access (UNIVATS), multiportal access (MVATS), or hybrid approach (minimally invasive hybrid open surgery, MIHOS). Methods Peripheral blood-derived inflammation markers (neutrophil-to-lymphocyte [NTL] ratio, platelet-to-lymphocyte [PTL] ratio, and systemic immune-inflammation index [SII]) were measured preoperatively and until postoperative day 5 in 109 patients undergoing UNIVATS, MVATS, or MIHOS lobectomy. Differences were compared through repeated-measure analysis of variance, before and after 1:1:1 propensity score matching. Time-to-event analysis was also done by measuring time to NTL normalization, based on the reliability change index for each patient. Results After UNIVATS, there was a faster decrease in NTL ratio (p = 0.015) and SII (p = 0.019) compared with other approaches. MVATS exhibited more pronounced PTL rebound (p = 0.011). However, all these differences disappeared in matched analysis. After MIHOS, NTL ratio normalization took longer (mean difference: 0.7 ± 0.2 days, p = 0.047), yet MIHOS was not independently associated with slower normalization at Cox's regression analysis (p = 0.255, odds ratio: 1.6, confidence interval: 0.7–4.0). Furthermore, surgical access was not associated with cumulative postoperative morbidity, nor was it with incidence of postoperative pneumonia. Conclusion In this study, different VATS approaches resulted into unsubstantial differences in postoperative systemic inflammatory response, after adjusting for confounders. The majority of patients returned back to preoperative values by postoperative day 5 independently on the adopted surgical access. Further studies are needed to elaborate whether these small differences may still be relevant to patient management.

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“…Recent clinical studies have provided similar evidences that are based on interim biomarkers and correlative evidence ( Shaashua et al, 2017 ; Haldar et al, 2018 , 2020 ; Hiller et al, 2019 ; Ricon et al, 2019 ; Knight et al, 2020 ). Consequently, it becomes clear that the perioperative period as a whole entails heightened risks for cancer progression but also offers unexploited treatment targets for improving resistance to cancer metastasis ( Hiller et al, 2018 ; Matzner et al, 2019 ; Ben-Eliyahu, 2003 ; Benish et al, 2008 )–the leading cause of cancer mortality ( Mehlen and Puisieux, 2006 ). We therefore suggest that further research on humans should focus on the impact of interventions conducted during the entire perioperative time frame.…”

Section: Limitationsmentioning

confidence: 99%

“…Interestingly, translational studies have indicated that the psychological stress that precedes surgery has an additive or even synergistic deleterious effect on the physiological trauma of surgery, leading to greater immune suppression and tumor progression ( Matzner et al, 2019 , 2020 ). Furthermore, prolonged psychological stress can lead to chronic inflammatory processes ( Hanahan and Weinberg, 2011 ), virally induced malignant processes, and defective DNA repair–all processes that foster cancer development and metastasis ( Cole et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Pre-operative Psychological Interventions on Psychological, Physiological, and Immunological Indices in Oncology Patients: A Scoping Review

et al. 2022

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IntroductionThe stressful pre-operative period exerts a profound impact on psychological, physiological and immunological outcomes. Oncological surgeries, in particular, elicit significantly higher stress responses than most other surgeries. Managing these responses through psychological interventions may improve long-term outcomes. The purpose of the current research was to review studies that have explored pre-operative psychological interventions in cancer patients in order to map the types of current interventions and provide an initial assessment of whether these interventions improved psychological, physiological, and/or immunological indices as well as long-term cancer outcomes.MethodsA systematic literature search for studies that included pre-operative psychological interventions in oncology patients was conducted, using the databases PubMed and Web of Science. Inclusion criteria included studies pertaining to oncological surgery in adults, study designs that included a clearly defined pre-operative psychological intervention and control group.ResultsWe found 44 studies, each using one of the following interventions: psychoeducation, cognitive interventions, relaxation techniques, integrated approaches. All the studies reported improved immediate post-operative psychological, physiological, and/or immunological outcomes. Only a few studies addressed long-term cancer outcomes, and only one reported improved survival.ConclusionsResearch on pre-operative interventions with cancer patients is missing systematic methods. Studies provide varying results, which makes it difficult to compare them and reach reliable conclusions. There is considerable heterogeneity in the literature regarding the specific intervention used, the timing of intervention, the characteristics of the patients studied and the outcome measures. In order to improve research in this field, including the measurement of long-term outcomes, we suggest some steps that should be taken in further research.

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Deleterious synergistic effects of distress and surgery on cancer metastasis: Abolishment through an integrated perioperative immune-stimulating stress-inflammatory-reducing intervention

Cited by 19 publications

References 44 publications

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

Surgery as an Emotional Strain: An Observational Study in Patients Undergoing Elective Colorectal Surgery

Systemic Inflammation after Uniport, Multiport, or Hybrid VATS Lobectomy for Lung Cancer

The Effect of Pre-operative Psychological Interventions on Psychological, Physiological, and Immunological Indices in Oncology Patients: A Scoping Review

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