Pancreatic Cancer and Microenvironments: Implications of Anesthesia

Abstract

Pancreatic malignancy is a lethal neoplasm, as well as one of the leading causes of cancer-associated mortality, having a 5-year overall survival rate of less than 10%. The average life expectancy of patients with advanced pancreatic cancer does not exceed six months. Although surgical excision is a favorable modality for long-term survival of pancreatic neoplasm, metastasis is initially identified in nearly 80% of the patients by the time of diagnosis, making the development of therapeutic policy for pancreatic cancer extremely daunting. Emerging evidence shows that pancreatic neoplastic cells interact intimately with a complicated microenvironment that can foster drug resistance, metastasis, or relapse in pancreatic cancer. As a result, the necessity of gaining further insight should be focused on the pancreatic microenvironment contributing to cancer progression. Numerous evidence reveals that perioperative factors, including surgical manipulation and anesthetics (e.g., propofol, volatile anesthetics, local anesthetics, epidural anesthesia/analgesia, midazolam), analgesics (e.g., opioids, non-steroidal anti-inflammatory drugs, tramadol), and anesthetic adjuvants (such as ketamine and dexmedetomidine), might alter the tumor microenvironment and cancer progression by affecting perioperative inflammatory or immune responses during cancer surgery. Therefore, the anesthesiologist plays an important role in perioperative management and may affect surgical outcomes. However, the literature on the impact of anesthesia on the pancreatic cancer microenvironment and progression is limited. This review summarizes the current knowledge of the implications of anesthesia in the pancreatic microenvironment and provides future anesthetic strategies for improving pancreatic cancer survival rates.

Multiphasic Heterogeneity of Fibroblasts in the Microenvironment of Pancreatic Ductal Adenocarcinoma: Dissection and the Sum of the Dynamics

“…In this Special Issue, "Tumor Microenvironment and Pancreatic Cancer", various aspects of PDAC TME are discussed: the heterogeneity of cancer-associated fibroblasts (CAFs), including cancer-promoting and cancer-restraining properties [16][17][18], the significance of the extracellular matrix (ECM) and targeting the ECM components [19][20][21], the dynamics of the immune microenvironment, [22,23], the metabolic property of PDAC cells in the TME [24], the association of PDAC TME and the microbiome [25], as well as neural signaling, [26], and the effect of anesthetic drugs on PDAC [27]. This evidence indicates that the PDAC microenvironment is more complicated than expected.…”

Evaluation of macro-micronutrient intake in overweight people in Grodno, Belarus

“…Obesity is a multi-cause disease characterized by excessive fat accumulation, which leads to health problems and chronic diseases in the future [1]. Based on the concept of energy imbalance, which is the main cause of this disease, weight loss in patients with metabolic obesity can be achieved by reducing the energy value of the diet, which leads to energy deficiency and stimulates fat mobilization from fat depots.…”

Effects of Ketamine, S-Ketamine and MK 801 on Integrin Beta-3-mediated Cell Migration in Pancreatic Carcinoma

“…With increasing incidence rates in western industrialised countries and a 5-year survival rate of less than 10% after diagnosis [ 1 ], pancreatic carcinoma is the fourth most common tumour-related cause of death in Germany and other western countries [ 2 ]. Although some progress in the molecular and biological understanding of pancreatic carcinoma has been made in recent years [ 3 ], patients’ survival rates have not significantly improved. Long-term survival is still almost impossible [ 4 ].…”