The Role of Dexmedetomidine in Tumor-Progressive Factors in the Perioperative Period and Cancer Recurrence: A Narrative Review

Abstract

Dexmedetomidine, a specific α2 adrenergic receptor agonist, is highly frequently used in the perioperatively for its favorable pharmacology, such as mitigating postoperative cognitive dysfunction. Increasing attention has been recently focused on the effect of whether dexmedetomidine influences cancer recurrence, which urges the discussion of the role of dexmedetomidine in tumor-progressive factors. The pharmacologic characteristics of dexmedetomidine, the tumor-progressive factors in the perioperative period, and the relationships between dexmedetomidine and tumor-progressive factors were described in this review. Available evidence suggests that dexmedetomidine could reduce the degree of immune function suppression, such as keeping the number of CD3+ cells, NK cells, CD4+/CD8+ ratio, and Th1/Th2 ratio stable and decreasing the level of proinflammatory cytokine (interleukin 6 and tumor necrosis factor-alpha) during cancer operations. However, dexmedetomidine exhibits different roles in cell biological behavior depending on cancer cell types. The conclusions on whether dexmedetomidine would influence cancer recurrence could not be currently drawn for the lack of strong clinical evidence. Therefore, this is still a new area that needs further exploration.

Effects of dexmedetomidine on oxidative stress, programmed cell death, liver function, and expression of peripheral immune cells in patients with primary liver cancer undergoing hepatectomy

“… Chen et al (2020) reported that Dexmedetomidine suppresses or induces immune cell functions, implying better expression. One study reported that Dexmedetomidine somewhat reduces the magnitude of immune function suppression, giving way to cancer development ( Cai et al, 2022 ). The expression of peripheral immune cells is the downside of Dexmedetomidine among primary liver cancer patients undergoing hepatectomy.…”

“…The induction of proinflammatory cytokine and chemokines (interleukin-2) is detrimental among primary liver cancer patients who have undergone hepatectomy ( Sachdeva et al, 2015 ; Sachdeva and Arora, 2020 ; Cai et al, 2022 ; Chen et al, 2022 ; Lu et al, 2022 ). From the observations above, we could conclude that Dexmedetomidine could be a potential agent against the progression of primary liver cancer.…”

Dexmedetomidine promotes ferroptotic cell death in gastric cancer via hsa_circ_0008035/miR‐302a/E2F7axis

“…Noteworthily, DEX regulates the malignant phenotype of breast cancer cells 7 and ovarian cancer cells 8 in vivo and in vitro. Importantly, it has been confirmed that DEX exhibits different roles in cell biological behavior depending on cancer cell types 9 . Previous studies on DEX in GC have mostly focused on clinical aspects.…”

“…Importantly, it has been confirmed that DEX exhibits different roles in cell biological behavior depending on cancer cell types. 9 Previous studies on DEX in GC have mostly focused on clinical aspects. Studies on DEX on postoperative analgesia and cellular immune function, 10 and postoperative cognitive function 5 in patients undergoing radical gastric cancer surgery have confirmed the safety of DEX anesthesia in surgery.…”

Effects of Dexmedetomidine on Systemic Inflammation and Postoperative Complications in Laparoscopic Pancreaticoduodenectomy: A Double‐blind Randomized Controlled Trial

“…Another clinical trial showed that the elderly patients in ICU impacting of DEX increase the 2-year survival rate postoperatively [ 15 ]. The application of DEX has also been implied to influence oncological prognosis [ 16 ]. Despite the possible beneficial effects of DEX on perioperative patients, its role in pancreatic cancer surgery has not been well established.…”