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Perioperative Biologic Perturbation and Cancer Surgery: Targeting the Adrenergic-Inflammatory Response and Microcirculatory Dysregulation

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Perioperative Inflammation as Triggering Origin of Metastasis Development

Abstract

Many of the physiological responses that comprise the surgical stress response are known to promote cancer-signaling pathways. Tissue resection and exposure to the pharmaco-physiological stressors of anesthesia required for surgery activate local and systemic inflammatory cytokines, up-regulate cyclooxygenase with increased prostaglandin production, and increase adrenergic activity. The activation of neuro-hormonal pathways is increasingly linked with cancer propagation. Retrospective evidence suggests that the use of anesthetic techniques and adjuncts that modulate these pathways and commonly available to practicing anesthesiologists may benefit patients scheduled for cancer surgery. Minimising the inflammatory response, preventing perioperative immunosuppression, and optimizing fluid delivery may have oncological benefits (improved disease free survival, reduced postoperative complications with timely delivery of adjuvant therapies) that extend beyond enhanced postoperative recovery. This review will consider key components of local and systemic inflammatory response, relevant immune cell mediators, perioperative endothelial dysfunction, and relevant perioperative therapies specific to the care of the patient receiving cancer surgery.

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Authors and Affiliations

  1. Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Jonathan Hiller MBBS (Hons.), GCEpi, FANZCA & Bernhard Riedel MBChB, FCA, FANZCA, PhD

  2. University of Melbourne, Parkville, VIC, Australia

    Jonathan Hiller MBBS (Hons.), GCEpi, FANZCA & Bernhard Riedel MBChB, FCA, FANZCA, PhD

  3. Monash University, Clayton, VIC, Australia

    Jonathan Hiller MBBS (Hons.), GCEpi, FANZCA

  4. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany

    Robert Schier M.D., Ph.D.

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  1. Jonathan Hiller MBBS (Hons.), GCEpi, FANZCA
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  2. Robert Schier M.D., Ph.D.
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  3. Bernhard Riedel MBChB, FCA, FANZCA, PhD
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Correspondence to Jonathan Hiller MBBS (Hons.), GCEpi, FANZCA .

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Editors and Affiliations

  1. Harvard TH Chan School of Public Health, Boston, Massachusetts, USA

    Michael W. Retsky

  2. Istituto Nazionale Tumori di Milano, Fondazione IRCCS, Milan, Italy

    Romano Demicheli

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Hiller, J., Schier, R., Riedel, B. (2017). Perioperative Biologic Perturbation and Cancer Surgery: Targeting the Adrenergic-Inflammatory Response and Microcirculatory Dysregulation. In: Retsky, M., Demicheli, R. (eds) Perioperative Inflammation as Triggering Origin of Metastasis Development. Springer, Cham. https://doi.org/10.1007/978-3-319-57943-6_4

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