Postoperative Cancer Recurrence Research Articles

Organ-specific variations in tumor marker dynamics in postoperative pancreatic cancer recurrence: Trends in lung and liver recurrence highlighting biological heterogeneity

Background/ObjectivesAlthough tumor recurrence after surgical resection in pancreatic cancer (PC) is generally considered incurable, it is well-accepted that clinical presentations and outcomes vary according to the recurrent sites (e.g., liver vs. lung recurrence), suggesting a possible biological inhomogeneity of PC recurrence. Understanding the behavior of biological factors, specifically tumor markers (TMs), at different recurrence sites may contribute to individualized treatment strategies. Therefore, this study aimed to compare the dynamics of pre-recurrence TMs at liver and lung recurrence sites. MethodsPatients with isolated postoperative liver or lung recurrence as their first recurrence were enrolled. Starting from the recurrence date confirmed by imaging examinations, the values of TMs (carbohydrate antigen 19-9: CA19-9; carcinoembryonic antigen: CEA) were retrospectively evaluated 6 and 3 months before recurrence and at the time of recurrence. ResultsPatients with liver recurrence displayed a significant increase in CA19-9 and CEA levels from as early as 6 months before recurrence. Contrastingly, patients with lung recurrence demonstrated a significant elevation of CA19-9 levels starting from 3 months before recurrence, with no increase in CEA levels, even at the time of recurrence. The relative change in CA19-9 and CEA levels during each period were significantly lower in patients with lung recurrence. ConclusionsBoth TMs exhibited organ-specific variations in patients with postoperative PC recurrence. This disparity may reflect the biological heterogeneity of PC between recurrence patterns, thereby highlighting the importance of conducting postoperative follow-up with consideration of this fact.

Artificial intelligence as a negative predictive tool for breast cancer postoperative recurrence

BackgroundMammography alone is an ineffective method for breast cancer surveillance and diagnosing cancer recurrence. The aim was to evaluate the ability of artificial intelligence (AI) to read digital mammograms as an additive tool to exclude recurrence in the operative bed of known breast cancer patients following the different surgical procedures.MethodsWe used a retrospective cohort study of post-surgery mammograms (n = 577). Imaging was performed within 6 months after the surgery or more. The AI solution used to read mammograms (AI-MMG) provided a targeted heat map of the operative bed, which was supported by a decision likelihood score percentage of cancer recurrence. The reference for suspicious or malignant-looking abnormalities (n = 62, 12.3%) was diagnosed by biopsy. A clear operative bed and benign-looking changes (n = 442) were confirmed by ultrasound characterization patterns and one year of intermittent follow-up.ResultsThe AI scoring percentage for a clear operative bed ranged between 0 and 26%, with a mean of 15% ± 5.4%. Operative bed benign changes ranged from 10 to 88%, with a mean of 48.2% ± 21.2%, while malignancy recurrence ranged from 65 to 99%, with an average of 87.7% ± 10.5%. The “ROC: Receiver Operating Characteristic” curve for AI to predict cancer in the surgical bed on mammograms was 0.906. The optimum cutoff value to distinguish between benign postoperative alterations and malignancy recurrence was 56.5% (95%, CI 0.824–1.060, p value < 0.001).Excellent agreement between AI-MMG and pathology or ultrasound results was observed, and Kappa was 0.894, p value < 0.001.ConclusionsThe use of artificial intelligence has enhanced the diagnostic performance of the postoperative mammograms to rule out recurrent malignancies in breast cancer surveillance.

Finding the minimum number of retrieved lymph nodes and negative lymph nodes in gastric cancer surgery: a real-world study.

Lymph node retrieval deficiency can lead to understagement and postoperative cancer recurrence, it is crucial to establish the standard number of retrieved lymph nodes (rLNs) and negative lymph nodes (nLNs) for patients undergoing gastrectomy. Patients who has gastric adenocarcinoma and underwent either radical subtotal gastrectomy (RSG) or radical total gastrectomy (RTG) between 2000 and 2022 were retrospectively included. We utilized restricted cubic spline (RCS) analysis to determine the ideal threshold for rLNs and nLNs. Survival analysis was conducted using Kaplan-Meier (KM) curves, log-rank tests and forest plots. Propensity score matching (PSM) was utilized to balance parameters between two groups. The median follow-up time for this study was 3,095 days. Our study found that there are significant tumor characteristic differences between RSG and RTG. For patients with N0-N3a stage undergoing RSG, retrieving≥24 lymph nodes intraoperatively were associated with better prognosis both before and after PSM (OS: P<0.001, P=0.019); whereas for N3b stage, at least 32 rLNs were required (OS: P=0.006, P=0.023). Similarly, for patients with N0-N3a stage undergoing RTG, retrieving≥27 lymph nodes intraoperatively were associated with better prognosis both before and after PSM (OS: P<0.001, P=0.047); whereas for N3b stage, at least 34 rLNs were required (OS: P<0.001, P=0.003). Additionally, for patients undergoing RSG, having ≥21 nLNs (OS: P<0.001, P=0.013), and for those undergoing RTG, having ≥22 nLNs (OS: P<0.001, P<0.001), were also associated with better prognosis both before and after PSM. For patients receiving RSG, rLNs should reach 24 when lymph nodes are limited, and 32 when lymph node metastasis is more extensive, with a minimum number of nLNs ideally reaching 21. Similarly, for patients receiving RTG, rLNs should reach 27 when lymph nodes are limited, 34 when lymph node metastasis is more extensive, and a minimum number of nLNs ideally reaching 22.

Perioperative Ketamine and Cancer Recurrence: A Comprehensive Review.

Cancer is a significant global health threat and a leading cause of death worldwide. Effective early-stage interventions, particularly surgery, can potentially cure many solid tumors. However, the risk of postoperative cancer recurrence remains high. Recent research highlights the influence of perioperative anesthetic and analgesic choices on the fate of residual cancer cells, potentially affecting recurrence risks. Among these agents, ketamine-a well-known anesthetic and analgesic-has garnered interest due to its antitumor properties, mainly through inhibiting the N-methyl-D-aspartate (NMDA) receptor found in various cancer tissues. Additionally, ketamine's potential immunomodulatory effects, given the expression of NMDA receptors on immune cells, suggest that it plays a significant role during the perioperative period. This review synthesizes current evidence on ketamine's impact on cancer cell biology, inflammation, immune modulation, and the role of the gut microbiota, proposing ketamine as a promising agent for enhancing oncological outcomes.

Early Gastric Cancers in Central Norway 2001 to 2016-A Population-Based Study.

Early gastric cancers (EGCs) are confined to the gastric mucosa and submucosa irrespective of lymph node metastases and constitute only a minor proportion of gastric cancer in Western countries. We aimed to characterize EGCs and assess the survival of EGC in Central Norway during 2001-2016. A retrospective population-based study on 1205 patients with gastric cancer was performed. At the time, surgical resection was the standard treatment, and 88 (7.3%) EGCs were identified. Histopathological specimens were re-examined, and the eCura score and survival were evaluated. The number of gastric cancers declined (p = 0.010), but the relative proportion of EGC was unchanged during the study period. EGCs were more often of the Lauren intestinal type (p < 0.001) compared with controls. A significant proportion (9.4%, n = 5) of the patients with a low-risk eCura had lymph node metastases, whereas further exclusion of tumors with histological ulceration or SM2 invasion identified an N0 cohort. The median survival for EGC patients was 117.1 months (95% CI 99.8-134.3) and the 5-year overall survival was 75%. Twelve deaths were cancer-related, either due to postoperative complications (5.7%, n = 5) or cancer recurrence (8%, n = 7). In conclusion, EGCs constituted a minor but constant proportion of gastric cancers. eCura alone was insufficient in predicting patients with pN0 disease.

Use of artificial intelligence in breast surgery: a narrative review.

We have witnessed tremendous advances in artificial intelligence (AI) technologies. Breast surgery, a subspecialty of general surgery, has notably benefited from AI technologies. This review aims to evaluate how AI has been integrated into breast surgery practices, to assess its effectiveness in improving surgical outcomes and operational efficiency, and to identify potential areas for future research and application. Two authors independently conducted a comprehensive search of PubMed, Google Scholar, EMBASE, and Cochrane CENTRAL databases from January 1, 1950, to September 4, 2023, employing keywords pertinent to AI in conjunction with breast surgery or cancer. The search focused on English language publications, where relevance was determined through meticulous screening of titles, abstracts, and full-texts, followed by an additional review of references within these articles. The review covered a range of studies illustrating the applications of AI in breast surgery encompassing lesion diagnosis to postoperative follow-up. Publications focusing specifically on breast reconstruction were excluded. AI models have preoperative, intraoperative, and postoperative applications in the field of breast surgery. Using breast imaging scans and patient data, AI models have been designed to predict the risk of breast cancer and determine the need for breast cancer surgery. In addition, using breast imaging scans and histopathological slides, models were used for detecting, classifying, segmenting, grading, and staging breast tumors. Preoperative applications included patient education and the display of expected aesthetic outcomes. Models were also designed to provide intraoperative assistance for precise tumor resection and margin status assessment. As well, AI was used to predict postoperative complications, survival, and cancer recurrence. Extra research is required to move AI models from the experimental stage to actual implementation in healthcare. With the rapid evolution of AI, further applications are expected in the coming years including direct performance of breast surgery. Breast surgeons should be updated with the advances in AI applications in breast surgery to provide the best care for their patients.

A Biodegradable Nanosuspension Locally Used for Inhibiting Postoperative Recurrence and Brain Metastasis of Breast Cancer.

Addressing the urgent need to prevent breast cancer postoperative recurrence and brain metastasis, Fe-metal organic framework (MOF)-coated hollow mesoporous organosilica nanoparticles (HMON) with tumor microenvironment dual-responsive degradability were prepared to encapsulate doxorubicin (DOX), formulating a tissue-adhesive nanosuspension for perioperative topical medication. This nanosuspension can not only retain the sustainably released drug in the postoperative residual tumor sites but also enhance the intracellular oxidative stress of tumors for remarkable tumor ferroptosis. Interestingly, the nanosuspension can act as an immune amplifier, which could not only stimulate DC cells to secrete chemokines for T cell recruitment but also elevate antigen exposure to facilitate the antigen presentation in lymph nodes. Thus, this nanosuspension could significantly activate antitumor immune responses in both in situ tumors and metastatic encephaloma for enhanced immunotherapy. In conjunction with the clinical PD-1 antibody, the locally administered nanosuspension could achieve an advanced therapeutic outcome for inhibiting postoperative recurrence and metastasis.

Impact of inflammation and the immune system on hepatocellular carcinoma recurrence after hepatectomy.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Hepatectomy remains the first-line treatment for patients with resectable HCC. However, the reported recurrence rate of HCC at 5 years after surgery is between 50% and 70%. Tumor-related factors, including tumor size, number and differentiation, and underlying liver disease are well-known risk factors for recurrence after treatment. In addition to tumor-related factors, ever-increasing amounts of studies are finding that the tumor microenvironment also plays an important role in the recurrence of HCC, including systemic inflammatory response and immune regulation. Based on this, some inflammatory and immune markers were used in predicting postoperative cancer recurrence. These include neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, cytotoxic T cells, and regulatory T cells, among others. In this review, we summarized the inflammatory and immune markers that affect recurrence after HCC resection in order to provide direction for adjuvant therapy after HCC resection and ultimately achieve the goal of reducing recurrence.

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy.

Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis. Postoperative adjuvant external radiation therapy (RT) has been shown to effectively prevent recurrence after liver cancer resection. However, there are multiple RT techniques available, and the differential effects of these techniques in preventing postoperative liver cancer recurrence require further investigation. To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival (OS) and disease-free survival (DFS) and to determine the optimal strategy. This study involved network meta-analyses and followed the PRISMA guidelines. The data of qualified studies published before July 10, 2023, were collected from PubMed, Embase, the Web of Science, and the Cochrane Library. We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints. The magnitudes of the effects were determined using risk ratios with 95% confidential intervals. The results were analyzed using R software and STATA software. A total of 12 studies, including 1265 patients with hepatocellular carcinoma (HCC) after liver resection, were included in this study. There was no significant heterogeneity in the direct paired comparisons, and there were no significant differences in the inclusion or exclusion criteria, intervention measures, or outcome indicators, meeting the assumptions of heterogeneity and transitivity. OS analysis revealed that patients who underwent stereotactic body radiotherapy (SBRT) after resection had longer OS than those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS. Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT. HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT. IMRT, a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT, may be a preferred option.

Robustly federated learning model for identifying high-risk patients with postoperative gastric cancer recurrence

The prediction of patient disease risk via computed tomography (CT) images and artificial intelligence techniques shows great potential. However, training a robust artificial intelligence model typically requires large-scale data support. In practice, the collection of medical data faces obstacles related to privacy protection. Therefore, the present study aims to establish a robust federated learning model to overcome the data island problem and identify high-risk patients with postoperative gastric cancer recurrence in a multicentre, cross-institution setting, thereby enabling robust treatment with significant value. In the present study, we collect data from four independent medical institutions for experimentation. The robust federated learning model algorithm yields area under the receiver operating characteristic curve (AUC) values of 0.710, 0.798, 0.809, and 0.869 across four data centres. Additionally, the effectiveness of the algorithm is evaluated, and both adaptive and common features are identified through analysis.

The association between surgical site infection and postoperative colorectal cancer recurrence and the effect of laparoscopic surgery on prognosis.

Studies have shown that surgical site infection (SSI) incidence is lower in patients undergoing laparoscopic surgery. Therefore, we reported the SSI countermeasures adopted by our institution and aimed to evaluate the association between SSI occurrence and postoperative colorectal cancer recurrence and the usefulness of laparoscopic surgery for prognosis. Among the patients with colorectal cancer who underwent radical surgery at our hospital between January 2015 and December 2017, 197 with stage I-III cancer without distant metastases were included. We retrospectively analyzed patients' electronic medical records and classified them into the non-SSI (without SSI, n = 159) and SSI (with SSI, n = 38) groups. We calculated and compared the 5-year relapse-free survival (RFS) and overall survival (OS) rates. Additionally, we assessed the relationship between prognosis in the non-SSI, incisional SSI, and organ/space SSI groups and the usefulness of laparoscopic surgery. The 5-year RFS and OS were 80.5% versus 63.2% (P = 0.024; hazard ratio [HR], 2.065; 95% confidence interval [CI], 1.099-3.883) and 88.7% versus 84.2% (P = 0.443; HR, 1.436; 95% CI, 0.570-3.617), respectively. The SSI group had a significantly worse 5-year RFS prognosis. Regarding the relationship with laparoscopic surgery, the SSI incidence was 45.0% (9/20 cases) and 16.4% (29/177 cases) with laparotomy and laparoscopic surgery, respectively, indicating a significantly reduced SSI occurrence with laparoscopic surgery (P = 0.005). Patients with SSI were at high risk for colorectal cancer recurrence, and laparoscopic surgery may be useful for reducing SSI.

Correlation between the expressions of metastasis-associated factor-1 in colon cancer and vacuolar ATP synthase.

Clinical prognosis often worsens due to high recurrence rates following radical surgery for colon cancer. The examination of high-risk recurrence factors post-surgery provides critical insights for disease evaluation and treatment planning. To explore the relationship between metastasis-associated factor-1 in colon cancer (MACC1) and vacuolar ATP synthase (V-ATPase) expression in colon cancer tissues, and recurrence rate in patients undergoing radical colon cancer surgery. We selected 104 patients treated with radical colon cancer surgery at our hospital from January 2018 to June 2021. Immunohistochemical staining was utilized to assess the expression levels of MACC1 and V-ATPase in these patients. The rates of MACC1 and V-ATPase positivity were 64.42% and 67.31%, respectively, in colon cancer tissues, which were significantly higher than in paracancerous tissues (P < 0.05). Among patients with TNM stage III, medium to low differentiation, and lymph node metastasis, the positive rates of MACC1 and V-ATPase were significantly elevated in comparison to patients with TNM stage I-II, high differentiation, and no lymph node metastasis (P < 0.05). The rate of MACC1 positivity was 76.67% in patients with tumor diameters > 5 cm, notably higher than in patients with tumor diameters ≤ 5 cm (P < 0.05). We observed a positive correlation between MACC1 and V-ATPase expression (rs = 0.797, P < 0.05). The positive rates of MACC1 and V-ATPase were significantly higher in patients with recurrence compared to those without (P < 0.05). Logistic regression analysis revealed TNM stage, lymph node metastasis, MACC1 expression, and V-ATPase expression as risk factors for postoperative colon cancer recurrence (OR = 6.322, 3.435, 2.683, and 2.421; P < 0.05). The upregulated expression of MACC1 and V-ATPase in colon cancer patients appears to correlate with clinicopathological features and post-radical surgery recurrence.

Effects of propofol-based total intravenous anesthesia versus desflurane anesthesia on natural killer cell cytotoxicity after hepatocellular carcinoma resection

Abstract Background and Aims: Inhalation anesthesia suppresses the immune system and stimulates the growth of tumor cells, contrary to intravenous anesthesia. However, no consensus exists on which anesthetic technique is better for preventing cancer recurrence. Therefore, this study compared the effects of two different anesthetic techniques on natural killer cell cytotoxicity (NKCC) in hepatocellular carcinoma (HCC) patients undergoing open hepatic resection. Material and Methods: Patients diagnosed with nonmetastatic HCC were scheduled for hepatic resection and randomly assigned to receive either propofol- or desflurane-based anesthesia. The primary outcome was pre- and postoperative NKCC assay. Cytokine levels were assessed by measuring interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) levels, and the secondary outcome was postoperative cancer recurrence evaluated using diagnostic imaging scans for 2 years. Results: Twenty-eight patients were analyzed, including 15 and 13 in the total intravenous anesthesia (TIVA) and inhalation (INH) groups, respectively. Two patients in the INH group were excluded due to non-HCC postoperative pathologic results. At 24 h, the postoperative change in NKCC between both groups showed no significant differences at a ratio of effector cell: target cell = 1:1, 5:1, and 10:1 (P = 0.345, 0.345, and 0.565, respectively). Also, there were no significant differences in IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ levels (P = 0.588, 0.182, 0.730, 0.076, 0.518, 0.533, respectively). Postoperative tumor recurrence occurred in five and six patients in the TIVA and INH groups, respectively. Conclusion: NKCC did not differ significantly among HCC patients undergoing open hepatic resection under either propofol or desflurane anesthesia 24 h postoperatively.

Identification of high-risk factors for recurrence of colon cancer following complete mesocolic excision: An 8-year retrospective study.

Colon cancer recurrence is a common adverse outcome for patients after complete mesocolic excision (CME) and greatly affects the near-term and long-term prognosis of patients. This study aimed to develop a machine learning model that can identify high-risk factors before, during, and after surgery, and predict the occurrence of postoperative colon cancer recurrence. The study included 1187 patients with colon cancer, including 110 patients who had recurrent colon cancer. The researchers collected 44 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination information, type of surgery, and intraoperative information. Four machine learning algorithms, namely extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor algorithm (KNN), were used to construct the model. The researchers evaluated the model using the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA), and external validation. Among the four prediction models, the XGBoost algorithm performed the best. The ROC curve results showed that the AUC value of XGBoost was 0.962 in the training set and 0.952 in the validation set, indicating high prediction accuracy. The XGBoost model was stable during internal validation using the k-fold cross-validation method. The calibration curve demonstrated high predictive ability of the XGBoost model. The DCA curve showed that patients who received interventional treatment had a higher benefit rate under the XGBoost model. The external validation set's AUC value was 0.91, indicating good extrapolation of the XGBoost prediction model. The XGBoost machine learning algorithm-based prediction model for colon cancer recurrence has high prediction accuracy and clinical utility.

Therapeutic sponge prevents postoperative breast cancer recurrence by sustainably dissociating into CD44-targeted nanoplatform

Therapeutic sponge prevents postoperative breast cancer recurrence by sustainably dissociating into CD44-targeted nanoplatform

A Graph-Based Approach to Identify Factors Contributing to Postoperative Lung Cancer Recurrence among Patients with Non-Small-Cell Lung Cancer.

The accurate identification of the preoperative factors impacting postoperative cancer recurrence is crucial for optimizing neoadjuvant and adjuvant therapies and guiding follow-up treatment plans. We modeled the causal relationship between radiographical features derived from CT scans and the clinicopathologic factors associated with postoperative lung cancer recurrence and recurrence-free survival. A retrospective cohort of 363 non-small-cell lung cancer (NSCLC) patients who underwent lung resections with a minimum 5-year follow-up was analyzed. Body composition tissues and tumor features were quantified based on preoperative whole-body CT scans (acquired as a component of PET-CT scans) and chest CT scans, respectively. A novel causal graphical model was used to visualize the causal relationship between these factors. Variables were assessed using the intervention do-calculus adjustment (IDA) score. Direct predictors for recurrence-free survival included smoking history, T-stage, height, and intramuscular fat mass. Subcutaneous fat mass, visceral fat volume, and bone mass exerted the greatest influence on the model. For recurrence, the most significant variables were visceral fat volume, subcutaneous fat volume, and bone mass. Pathologic variables contributed to the recurrence model, with bone mass, TNM stage, and weight being the most important. Body composition, particularly adipose tissue distribution, significantly and causally impacted both recurrence and recurrence-free survival through interconnected relationships with other variables.

AB014. SOH23ABS_149. Exploring neutrophil-lymphocyte ratio as a predictor of postoperative breast cancer recurrence

Background: Neutrophil-lymphocyte ratio (NLR) is an emerging prognostic biomarker with potential utility in solid malignancies. Routine inclusion of the full blood count in preoperative workup and postoperative course positions NLR as a cost-effective adjunct in surveillance. This project explores associations between preoperative NLR and breast cancer recurrence.

Exploring neutrophil-lymphocyte ratio as a predictor of postoperative breast cancer recurrence

Exploring neutrophil-lymphocyte ratio as a predictor of postoperative breast cancer recurrence

Metabolic Syndrome and Clinical Outcomes of Patients with Gastric Cancer: A Meta-Analysis.

Metabolic syndrome (MetS) is suggested to participate in the pathogenesis and progress of some cancers via inducing low-grade systemic inflammation. However, the influence of MetS on patients with gastric cancer (GC) remains not fully determined. A systematic review and meta-analysis was therefore performed to evaluate the influence of MetS on clinical outcomes of patients with GC. A search of PubMed, Embase, Web of Science, Wanfang, and CNKI retrieved relevant cohort studies from the inception of the databases to October 11, 2022. We pooled the results using a random-effects model that incorporates heterogeneity. In the meta-analysis, 6649 patients with GC were included, and all of them received gastrectomy. A total of 1248 (18.8%) patients had MetS at baseline. Pooled results showed that MetS was associated with higher risks of postoperative complications [risk ratio (RR): 2.41, 95% confidence interval (CI): 1.85 to 3.14, p<0.001; I2=55%], overall mortality (RR: 1.73, 95% CI: 1.85 to 3.14, p<0.001; I2=77%), and recurrence of GC (RR: 2.00, 95% CI: 1.10 to 3.63, p=0.02; I2=39%). Subgroup analyses showed similar results in prospective and retrospective cohort studies and in studies with MetS diagnosed with the Chinese Diabetes Society criteria and the National Cholesterol Education Program Adult Treatment Panel III criteria (p for subgroup difference all>0.05). In patients with GC after gastrectomy, MetS may be a predictor of high incidence of postoperative complications, cancer recurrence, and overall mortality.

Do Certain Anaesthetic Drugs Affect Postoperative Cancer Recurrence Rates? Implications for Drug Discovery

Recurrence of cancer after primary tumour resection is a leading cause of cancer-related mortality. Preclinical research indicates that surgery induces a stress response that inhibits cell-mediated immunity as a possible basis for risk of recurrence. Other preclinical evidence suggests that, conversely, propofol and local anaesthetics diminish the effects of the surgical stress response and so could directly inhibit cancer progression, and this is supported by several retrospective cohort studies and meta-analyses. However, the first large-scale randomised clinical trial (RCT), comparing recurrence after mastectomy in patients anaesthetised with either propofol/local anaesthetic or sevoflurane/opioids, concluded that recurrence was not significantly improved in the propofol/local anaesthetic group (p = 0.84). Other cancers may prove more responsive and results from a number of ongoing RCTs, encompassing several cancer types, are currently awaited. These trials should establish whether choice of anaesthetic technique is an important determinant of cancer recurrence risk.