title: Cancer surgery: how may anesthesia influence outcome?
abstract: OBJECTIVE
  To review the published literature regarding the effects of anesthesia on cancer surgery to prevent tumor cell proliferation/migration or induce apoptosis.
  
  
  BACKGROUND
  Surgery is the main treatment for potentially curable solid tumors, but most cancer-related deaths in patients who have received previous surgical treatment are caused by metastatic disease. There is increasing evidence that anesthetic technique has the potential to affect long-term outcome after cancer surgery.
  
  
  METHODS
  This work reviews the English published literature that was obtained by performing a search of the PubMed database up to January 2014. We selected articles that provided evidence or reviewed the possible actions of anesthetics on cancer cells or the influence of anesthesia in recurrence/outcome.
  
  
  RESULTS
  Inhaled anesthetics induce immunosuppression and activate inflammatory cascade activation, whereas propofol has a protective action. Opioids might promote cancer recurrence and metastasis. In vitro and in vivo studies have demonstrated that local anesthetics inhibit proliferation and migration of cancer cells and induce apoptosis.
  
  
  CONCLUSIONS
  Anesthesiologists should follow current best clinical practice and include all strategies that effectively decrease pain and attenuate stress. Regional anesthesia and multimodal analgesia, adding anti-inflammatory drugs, play an unquestionable role in the control of perioperative pain and may improve recurrence-free survival.
authors.affiliation: IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain. Electronic address: fcassinello@fjd.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Cassinello
authors.affiliation: IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain. Electronic address: iprieto@fjd.es.
authors.forename: Isabel
authors.initials: I
authors.lastname: Prieto
authors.affiliation: IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: del Olmo
authors.affiliation: IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rivas
authors.affiliation: Pain Research Center, Department of Anesthesia. Harvard Medical School, Brigham and Women's Hospital, Boston, 02115 MA, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Strichartz
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000779:Anesthetics, Local / Q000494:pharmacology; D017209:Apoptosis; D002465:Cell Movement; D049109:Cell Proliferation; D018450:Disease Progression; D006801:Humans; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013373:Substance P / Q000502:physiology; D061566:Voltage-Gated Sodium Channels / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D061566:Voltage-Gated Sodium Channels; D013373:Substance P
keywords: Cancer surgery; Local anesthetics; Opioids; P-substance; Propofol; Regional anesthesia