title: Challenges in research related to perioperative cancer care and cancer outcomes.
abstract: Surgery is one of the most commonly used treatments to attempt cure of early-stage and some late-stage solid tumours. Paradoxically, surgery itself and some of the medical interventions involved in the perioperative care of cancer patients may be associated with an increased chance of metastasis. Researchers and perioperative clinicians have studied the phenomenon of surgery-induced immunosuppression and postoperative cancer recurrence for several decades. Unfortunately, the translation of basic science research into human studies is not clear. Moreover, a recent proliferation of retrospective studies with conflicting results and significant limitations has not shed light on the understanding of whether regional anaesthesia, anti-inflammatory interventions or blockade of the sympathetic response improve survival after cancer surgery. Ultimately, randomised controlled trials are required to answer some of the questions raised by preclinical and retrospective studies; however, investigators face many challenges in conducting these trials. Unless sufficient funding is obtained and cooperative research is developed in the near future, clinicians will not know whether anticancer perioperative interventions are useful to improve cancer-related survivals.
authors.affiliation: Department of Anaesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA. Electronic address: jcata@mdanderson.org.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
mesh_terms: D000765:Anesthesia, Conduction / Q000379:methods; D000818:Animals; D035843:Biomedical Research / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D057170:Translational Research, Biomedical / Q000379:methods*
keywords: cancer; clinical research; perioperative medicine; randomised control trial