The Effect of Anaesthetic and Analgesic Technique on Oncological Outcomes

Abstract

Purpose of Review

The purpose of this review is to provide an examination of the recent literature relating to anaesthesia and analgesia for cancer surgery and their potential effects on cancer recurrence and metastasis.

Recent Findings

Opioids continue to have mixed results in terms of their long-term effects on cancer outcomes. While laboratory evidence suggests alterations in immune responses and pro-tumourigenic effects via opioid receptors on cancer cells, clinical evidence is lacking. Regional anaesthesia has the ability to regulate surgical stress response, but retrospective studies provide conflicting results. However, lidocaine appears to have protective functions against cancer and anti-inflammatory properties making it a potentially useful agent perioperatively. An association also exists between the use of non-steroidal anti-inflammatory agents and improved perioperative outcomes; however, prospective clinical studies are required to provide more robust data in this area. Inhalational agents appear to confer increased risk of cancer recurrence in comparison to total intravenous anaesthesia (TIVA). A recent large retrospective trial and in vivo and in vitro evidence point to a beneficial effect of TIVA versus volatiles that should be fully investigated.

Summary

Retrospective analysis provides tenuous links between the techniques used perioperatively and potential cancer recurrence and metastasis. In vitro and in vivo animal studies have furthered research in the area, particularly providing mechanisms on how commonly used agents can affect patient outcomes. However, large prospective randomised control trials are required in this area to further the research on anaesthesia and its effects on cancer recurrence and metastasis.

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