abstract
PURPOSE:
A number of original publications and review articles have addressed the issue of perioperative immune modulation and cancer
outcome. The objective of this module is to review current
understanding surrounding the pathways involved and the evidence
implicating commonly used anesthetic agents.
PRINCIPAL FINDINGS:
Drugs
commonly used in anesthetic practice have been shown to affect various
components of the immune system in laboratory animal and human in vitro
models. It has been hypothesized that these effects may favour tumour
recurrence and metastasis formation. Inhalational agents and opiates
have potential negative immunomodulatory effects; on the other hand,
regional anesthesia and propofol may have positive effects on immune
function modulation. However, the clinical relevance of these studies to
human cancer
outcome is unknown since clinical trials are equivocal, and results of
in vitro and animal model studies cannot be extrapolated to clinical
practice. Furthermore, there is a lack of rigorous clinical trials
demonstrating clinical outcome benefit for one technique over another.
It remains unclear how anesthetic drugs influence the immune system in
relation to tumour cell elimination and clinical cancer outcome.
CONCLUSIONS:
Recommendations for a specific anesthetic technique based on cancer
outcome alone cannot be made. A pragmatic solution would be to offer
regional anesthesia in isolation or combined with propofol infusion to cancer
patients if appropriate and if local expertise is available. Regional
anesthesia offers excellent analgesia, a low incidence of postoperative
nausea and vomiting, and a favourable immunological profile based on
current understanding of laboratory evidence.
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