Surgery/
anesthetic technique-stimulated immunosuppression in the
perioperative period might cause an increase in
cancer-related mortality. Whether
anesthetic technique can affect the outcomes of
cancer patients remains inconclusive. This review discusses data from the available literature on
anesthetic techniques applied in oncologic surgery, the long-term outcomes of
anesthetic technique, and their relation to survival and
cancer recurrence. Searches of the PubMed database up to June 30, 2016, were conducted to identify publications with the terms "
anesthetic technique and
cancer recurrence," "
regional anesthesia and
cancer recurrence," "
local anesthesia and
cancer recurrence," "
anesthetic technique and immunosuppression," and "
anesthetic technique and oncologic surgery." Surgery/
anesthesia-stimulated activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) provides immunosuppression through several soluble factors. Volatile
anesthetics and
opioids suppress cell-mediated immunity (CMI) and promote the proliferation of
cancer cells and angiogenesis, whereas
propofol does not suppress CMI and inhibits
tumor angiogenesis.
Regional anesthesia (RA) protects CMI and diminishes the surgical neuroendocrine stress response by blocking afferent neural transmission that stimulates the HPA axis and SNS, decreasing the requirement for
opioids and volatile
anesthetics and thereby decreasing
cancer recurrence. Preclinical and retrospective studies highlight a potential benefit of
anesthetic technique in reducing
cancer-related mortality and recurrence by attenuating immunosuppression following surgical treatment in patients with specific types of
cancer. Several well-planned, prospective, randomized controlled trials (RCTs) are underway that may provide more conclusive and definitive results regarding the benefits of
anesthetic technique on survival in oncologic surgery.