Surgery for cancer: does anesthesia matter?

JG Bovill - Anesthesia & Analgesia, 2010 - journals.lww.com
JG Bovill
Anesthesia & Analgesia, 2010journals.lww.com
As anesthesiologists, we often assume that once the immediate effects of our drugs
dissipate, the body returns to the preanesthetic state without long-term sequelae. However,
in addition to profound immediate effects, anesthesia can also have long-term
consequences. In this issue of Anesthesia & Analgesia, 2 articles deal with 1 potentially
devastating consequence: an increased risk of metastatic spread of malignant cells after
cancer surgery. Gottschalk et al. 1 review the pathophysiology of cancer recurrence after …
As anesthesiologists, we often assume that once the immediate effects of our drugs dissipate, the body returns to the preanesthetic state without long-term sequelae. However, in addition to profound immediate effects, anesthesia can also have long-term consequences. In this issue of Anesthesia & Analgesia, 2 articles deal with 1 potentially devastating consequence: an increased risk of metastatic spread of malignant cells after cancer surgery. Gottschalk et al. 1 review the pathophysiology of cancer recurrence after surgery, the potential role of anesthesia on the risk of recurrence, and discuss how this might affect clinical practice. Their review is an opportune reminder that not all consequences of anesthesia disappear after the immediate postoperative period. The authors of the second article report findings from an analysis of tumor recurrence after surgery for breast cancer. 2 The results suggest that intraoperative administration of the nonsteroidal antiinflammatory drug (NSAID) ketorolac significantly decreases the incidence of cancer recurrence compared with non-NSAID analgesics.
Cancer is second only to cardiovascular disease as the most frequent cause of death among adults in the developed nations. Although cancer does occur in children and young adults, nearly 75% of cases occur in individuals aged 60 years and older, and more than one-third in those aged 75 years and older.* Populations in the developed countries are aging, with a concomitant increase in age-related diseases, including cancer. As a consequence, anesthesiologists will be confronted with increasing numbers of patients presenting for cancer surgery.
Lippincott Williams & Wilkins