Perioperative Immunosuppressive Factors during Cancer Surgery: An Updated Review

Autores de IIS La Fe

• 

  Óscar Díaz Cambronero

  Autor

Participantes ajenos a IIS La Fe

• Bezu, L
• Akcal Oeksuez, Dilara
• Bell, M
• Buggy, D
• Enlund, M
• Forget, P
• Gupta, A
• Hollmann, MW
• Ionescu, D
• Kirac, I
• Ma, DQ
• Mokini, Z
• Piegeler, T
• Pranzitelli, G
• Smith, L
• EuroPeriscope Grp

Grupos

• Medicina Perioperatoria, Anestesiología y Reanimación

Abstract

Simple Summary Removal of the primary tumor is the best treatment for solid tumor disease. However, perioperative factors such as surgical stress, pain, or anemia disrupt the innate and adaptive antitumor immune response and compromise the postoperative benefits of oncological surgery. Alternative strategies could be implemented during the perioperative period to improve immunosurveillance and reduce the incidence of recurrence. Here, we provide a comprehensive list of immunosuppressive factors occurring during the perioperative period and discuss pharmacological and non-pharmacological methods supporting the immune system, with the aim of assisting clinicians in their practice.Abstract Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics' impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.

Keywords

• anesthesia; cancer; immune factors; surgery