Anesthesia and Cancer Recurrence

Introduction: Various immunological mechanisms have been elucidated for the survival and propagation of cancer cells. Anesthesia has evolved from being able to facilitate surgery to being able to influence long-term outcomes. Anesthetic agents and techniques have been implicated in the modulation of the immunologic response, thereby enhancing or impeding tumor propagation. Clinical evidence: Preclinical studies have suggested that total intravenous anesthesia with opioid-sparing strategies, inclusion of regional anesthesia, and avoidance of inhalational anesthetic agents are associated with better oncological outcomes. However, the quality of evidence is low and inconsistent. Certain clinical studies have reiterated such association, while others have refuted. Inconsistency of evidence can be attributed to the various confounding factors influencing cancer recurrence. Long-term follow-up with stringent study conditions is required to generate high-quality evidence. Conclusion: Given the equivocal evidence relating anesthesia and cancer recurrence, further high-quality evidence in the form of well-planned prospective trials is required. Though cancer recurrence should be borne in mind while formulating a perioperative anesthetic care plan, various other factors like patient safety, patient comfort, surgical exposure, enhanced recovery, and return-to-intended oncologic treatment should take precedence based on current clinical evidence.