The impact of anaesthetic technique upon outcome in oncological surgery

Evans, Mark; Wigmore, Tim; Kelliher, Leigh

doi:10.1016/j.bjae.2018.09.008

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…5,6 In addition, increasing evidence that opioids stimulate cancer cell growth and activate metastatic pathways indicates the possibility that decreasing overall opioid use may contribute to improved cancer-specific survivals. [35][36][37] In addition to type of recovery pathway, preoperative opioid use and type of surgical approach were other factors predicting a greater likelihood of postoperative opioid requirement (OR 6.1 and OR 2.6, respectively). While the finding that preoperative opioid use predicts postoperative opioid use is not surprising or novel, 38,39 it does highlight the importance of a preoperative pain evaluation and presents an opportunity to identify patients at-risk for continued long-term opioid use postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Lillemoe

Marcus

Day

et al. 2019

Surgery

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Background: Pathways of Enhanced Recovery in Liver Surgery (ERILS) decrease inpatient opioid use, however, there is little existing data regarding their effect on discharge prescriptions and post-discharge opioid intake. Methods: For consecutive patients undergoing liver resection from 2011-2018, clinicopathologic factors were compared between patients exposed to ERILS and traditional pathways. Multivariable analysis was used to determine factors predictive for traditional opioid use at the first postoperative follow-up. The ERILS protocol included opioid-sparing analgesia, goal-directed fluid therapy, early postoperative feeding, and early ambulation. Results: Of 244 cases, 147 ERILS patients were compared to 97 traditional pathway patients. ERILS patients were older (median 57 vs. 52 years, p=0.031) and more frequently had minimally invasive operations (37% vs. 16%, p<0.001), with fewer major complications (2% vs. 9%, p=0.011). ERILS patients were less likely to be discharged with a prescription for traditional opioids (26% vs. 79%, p<0.001) and less likely to require opioids at their first postoperative visit (19% vs. 61%, p<0.001) despite similarly low, patient-reported pain scores (median 2/10 both groups, p=0.500). On multivariable analysis, traditional recovery pathway were associated with traditional opioid use at first follow-up (OR 6.4, 95% CI 3.5-12.1; p<0.001). Conclusions: The implementation of an ERILS pathway with opioid-sparing techniques was associated with decreased postoperative discharge prescriptions for opioids and outpatient opioid use after oncologic liver surgery, while achieving the same level of pain control. For this and other

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids

Lillemoe

Marcus

Day

et al. 2019

Surgery

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“…In this murine model of transplanted bone marrow neutrophils, indomethacin led to neutrophils' bactericidal function recovery post-transplant (in vivo) and diclofenac (in vitro), suggesting PGE 2 is an inhibitor of NET production [70]. Although various reviews have suggested either an equivocal or slightly positive signal for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in cancer surgery to improve oncological outcomes [33,[71][72][73], it remains unclear what is the role of NSAIDs in cancer-induced NET expression. The potential NET formation inhibitors are summarised in Table 2.…”

Section: Net Formation Modulatorsmentioning

confidence: 95%

Neutrophil Extracellular Trapping Role in Cancer, Metastases, and Cancer-Related Thrombosis: a Narrative Review of the Current Evidence Base

Efrimescu

Buggy

2021

Curr Oncol Rep

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Purpose of Review Neutrophil extracellular trap (NET) formation is a newly discovered, reactive oxygen species-dependent regulated process , whereby neutrophils degranulate and extrude genetic material, after engulfing various infectious or neoplastic antigens, culminating in a measurable serologic footprint. Recent research has highlighted the involvement of NETs in cancer and cancer-related pathologies. We review the role of NET formation in cancer biology, prognosis and potential therapeutic modulators. Recent Findings Elevated NET levels are associated with cancer metastasis and may be modified by some anaesthetic-analgesic techniques during tumour resection surgery. It promotes tumour cell migration, angiogenesis and hypercoagulability. Although there are potential anti-NET formation therapeutics available, their role has not been formally assessed in cancer patients. Summary Limited available evidence suggests an association between elevated NET expression and cancer metastasis, but its validity as a prognostic indicator for cancer-related outcomes is inconclusive. Further observational and interventional studies are warranted to comprehend the potential prognostic and therapeutic role of NETs in cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s11912-021-01103-0.

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“…Current evidence suggests that inhalational agents and opioid-based analgesia may have an adverse effect on cancer outcomes; l opioid receptors are over-expressed in colon and breast cancer cells, and opioid agonism of these receptors can promote vascular endothelial growth factor, increasing the expression of neuroepithelial transforming gene 1, augmenting cancer invasion and migration [7]. Total intravenous anaesthesia, local anaesthetics and regional anaesthesia may have some protective effects [8]. Surgery leads to a reduction in circulating natural killer cells as well as other lymphocytes, and, in a breast cancer study, serum was collected from patients undergoing surgery randomly allocated to propofol-based total intravenous anaesthesia (TIVA) or inhalational anaesthesia.…”

Section: Anaesthetic Techniquementioning

confidence: 99%