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Regional anesthesia and analgesia for cancer surgery
The evolution of cancer cells in clinical metastases depends on antimetastatic immune activity and the ability of the tumour to proliferate and generate new blood vessels (neoangiogenesis). Surgery by itself can depress cellular immunity and functions of cytotoxic T lymphocytes and natural killer (NK) cells. The perioperative stress response releases tumour cells into the circulation and anaesthesia further reduces immune functions, including the functions of neutrophils, macrophages, dendritic cells, T lymphocytes and NK cells. Effective treatment of postoperative pain could play an important role in limiting the metastatic migration following oncology surgery. Opioids used intraoperatively and postoperatively inhibit cellular and humoral immune functions in humans and have natural pro-angiogenic properties. In a retrospective analysis, paravertebral anaesthesia and analgesia for breast cancer surgery reduced the risk of recurrence or metastasis by four during the first years of follow-up. Similarly, following epidural anaesthesia for resection of the prostate, biochemical recurrence of prostate cancer was reduced by 65% and, following colon surgery, the oncological prognosis was enhanced in the first two years. To date there are only retrospective clinical studies available. A prospective, randomized, large-size study focused on cancers with high risk of recurrence is needed to determine if regional anaesthesia and analgesia could have potential for clinically reducing cancer recurrence after oncology surgery.
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