Perioperative Factors, Immunity and Cancer Recurrence

Abstract

Introduction: The quality criteria in radical oncological surgery are based on complete tumor removal, with free margins, without residual macroscopic disease, with adequate lymphadenectomy and minimal possible tumor manipulation. Despite achieving these objectives, non-visible residual disease or micrometastasis may remain, likely to grow and spread depending on tumor capacity and the host's defenses.

Objectives: To evaluate the influence of perioperative factors on the immunity of cancer patients operated on and the potential effect of anesthetic drugs on recurrence, as well as other perioperative factors that may affect long-term tumor spread.

Methods: An electronic bibliographic search was carried out of the articles published in the last ten years and that fulfilled the established objective.

Development: During the perioperative period, activation of the response to surgical stress triggers a series of complex neuroendocrine, humoral and immune reactions. Surgery, with unquestionable curative potential, is related to a state of immunosuppression due to activation of the hypothalamic-pituitary-adrenal axis and inflammation. On the other hand, anesthesia produces biomolecular changes that affect cellular immunity and the number of natural killers, which can influence cancer recurrence in the long term.

Conclusions: To reduce surgical and psychological stress, to control surgical pain, to maintain normothermia, and a judicious blood transfusion, in addition to an anesthetic technique with reduced opiates usage, can be beneficial to protect the body's antimetastatic immune response and can have a beneficial effect on oncological disease.