¿Influye la anestesia en los resultados de la cirugía oncológica?

Abstract

The following quality criteria management is considered in radical surgery for cancer, complete eradication of the tumor with negative surgical margins and without macroscopic residual tumor, adequate removal of lymph nodes and minimal manipulation of the tumor. Despite getting all these objectives, residual non-visible tumor or micrometastasis may persist after tumor resection therefore cancer cells can growth and disseminate depending on the aggressiveness of the tumor and host defenses. Three perioperative factors can contribute to cancer advance: a) Surgical manipulation that releases cancer cells to the bloodstream, diminishes cellular immunity, including T helper 1 (TH1) and natural killer (NK) cell activity, decreases anti-angiogenic factors and increases pro-angiogenic factors; b) general anaesthetics, except propofol, diminish cellular immunity; and c) opioids inhibit cellular and humoral immunity and promote cancer cell growth. Regional anaesthesia and analgesia block nociceptive afferents and decrease or eliminate acute postoperative pain. Combined with general anaesthesia would reduce the consumption of volatile anesthetics, potentially immunosuppressive. These actions preserve immunity due to the decrease of neuroendocrine and inflammatory response to stress and the consumption of opioids. Experimental studies support this hypothesis. Clinical studies show contradictory results. Since the year 2000, twenty one cancer studies for many types of cancer (breast, prostate, colon and rectum, lung, liver and melanoma) have been published. Sixteen Key words: Anaesthesia and cancer recurrence. Anaesthesia and metastasis. Analgesia and cancer recurrence. Regional anaesthesia and cancer. RESUMEN Los criterios de calidad en la cirugía oncológica radical se basan en la extirpación completa del tumor, con márgenes libres, sin enfermedad macroscópica residual, en una linfadenectomía adecuada y en la mínima manipulación tumoral posible. A pesar de conseguir estos objetivos, tras la extirpación puede quedar enfermedad residual no visible o micrometástasis,

Antitumor Anesthetic Strategy in the Perioperatory Period of the Oncological Patient: A Review

“…Both animal and human studies suggest that NK cell activity plays an essential role in disease-free survival after surgery (22). Regardless of factors, such as age, sex, differentiation, or tumor grade, the decreased NK cell activity predicts a high risk of tumor recurrence (23). Therefore, it should be noted that in cases of immunosuppression less activity and/or a number of NK cells, the host has a lower ability to cope with neoplastic cells, and consequently, the probability of metastasis increases (6).…”

“…The importance in clinical practice of these data is that probably any process that promotes angiogenesis, neuroendocrine, and inflammatory responses, or immunosuppression, will favor the development and formation of premetastatic niches, and thus provide the necessary microenvironment for the training of new metastases (6,23,30). It is vital to avoid the activation of these molecular pathways, as well as therapies specifically directed against the establishment of premetastatic niches are potential candidates to be considered new treatments against metastatic development.…”

¿Por qué el propofol en el paciente con cáncer?

“…todos los anestésicos excepto el propofol activan el factor inducido por la hipoxia (HIF) que se localiza en el centro de la masa tumoral, y que promueve la proliferación y migración celular, la diseminación hematógena y la angiogénesis. Se plantea que el potencial efecto organoprotector de los anestésicos volátiles frente a la lesión de isquemia reperfusión, pueda jugar un papel negativo en la preservación de la inmunidad celular [10].…”

“…nes linfocitarias citotóxicas, se cree que la iC juega un papel protagonista en la defensa antitumoral y anti-metastásica[10].-Angiogénesis: el desarrollo de nuevas redes capilares es vital para el crecimiento tumoral. Los tumores no pueden sobrevivir más allá de los 2 mm de diámetro sin angiogénesis.…”

“…y la diseminación tumoral y la angiogénesis. también se unen a los receptores b2 de las células citotóxicas, disminuyendo la inmunidad celular (IC)[10].-Activación del eje hipotálamo-hipofisarioadrenal: se produce una inmunosupresión por la liberación de glucocorticoides y CAt que inhiben la IC[10]. -Respuesta inflamatoria: se crea un microentorno tumoral con la liberación de citoquinas (CK), interleukinas (iL) y prostaglandinas (PG) que promueve la diseminación tumoral y la angiogénesis.…”