Abstract
The immune system plays a pivotal role against cancer. The development of a successful immune response involves the balance between the Th1 (antitumor) and Th2 (protumor) responses. Once this balance is lost, diseases such as cancer may become apparent. Surgical stress, volatile anaesthetics, opioids and blood transfusions are known to favour a Th2 response that manifests as immune suppression. During surgery the load of circulating malignant cancer cells is increased by tumour manipulation. These cancer cells can migrate and seed in distant tissues and form metastasis. Also, some cancer patients may present with micrometastasis that may become invasive if left untreated. Therefore, the perioperative period is a moment of immunological vulnerability in cancer patients. A better understanding of the factors that affect the Th1/Th2 balance may allow anaesthesiologists to identify patients at high risk for cancer recurrence. This review describes the perioperative interventions that can alter the Th1/Th2 balance, during the perioperative period of oncological surgery.
Highlights
The immune system plays a pivotal role in clearing new forming malignant cells and it does so by favouring antitumor mechanisms such as the production of cytokines
This review describes the perioperative interventions that can alter the Th1/Th2 balance, during the perioperative period of oncological surgery
The perioperative period of oncological surgery represents a moment of immunological vulnerability characterized by a predominant Th2 response
Summary
The immune system plays a pivotal role in clearing new forming malignant cells and it does so by favouring antitumor mechanisms such as the production of cytokines. This is the result of the cancer itself [6] malnutrition, chemotherapy, stress, concurrent diseases, medicationsand surgery [7] The latter remains as one of the main therapeutic options for a large number of solid cancers but there are perioperative factors that alter the balance between the Th1 and Th2 cytokines favouring a predominant Th2 (protumor) state. Those factors include surgery-induced stress, anaesthetics, analgesics and blood transfusion. In patients with oesophageal cancer, Sato et al [16] observed increased postsurgical serum concentrations of IL-8 and IL-10 that lasted 24 hours These cytokine profiles were similar to those found in patients with squamous cell carcinoma of the larynx. Summarizing, the Th2 state associated with surgery is due to an increased of the Th2 cytokines with a relative decrease or no change in the Th1 cytokines
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