Perioperative analgesia and its influence on cancer outcomes
Digestive Medicine Research
Cancer is a major cause of morbidity and mortality worldwide. Around two-thirds of those with solid tumors will require surgery as part of their treatment, and there is evidence that perioperative events may influence both short and longer-term outcomes. This may be linked to the creation of an environment that promotes cancer cell growth and potentially propagation of metastases, through the surgical stress response, seeding of cancer cells, and the anesthetic and analgesic drugs used. Given
... at our practice as anesthetists could influence patient outcomes, it is important to review all aspects of our care. Here we present a summary of the most up to date literature on the influence of perioperative analgesia on cancer outcomes, including in vitro, in vivo and clinical studies, and the subsequent implications for anesthetic practice. Laboratory data suggests that there could be a significant impact from systemic and regional analgesic drugs and techniques. However, most of the human research is either retrospective or involves systematic reviews and meta-analyses of studies whose primary outcomes were not to study cancer recurrence, and are therefore inconclusive with respect to this. In order for our clinical practice to change, further prospective randomized controlled trials (RCTs) are required to look at the effects of these agents during the perioperative period for a wide range of cancers.