Fig. 2
From: Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence
Hypothesis to explain cancer metastasis and recurrence caused by surgery- and anesthetic-induced immunosuppression in the perioperative period. Surgery, anesthesia, and analgesia stimulate the HPA-axis and SNS during the perioperative period. Activated neuroendocrine mediators lead to increases in several immunosuppressive soluble factors that promote tumor progression and metastasis, resulting in increase of cancer recurrence. Combined regional anesthesia with propofol decreases anesthesia-induced immunosuppression and avoids volatile anesthetics and opioids, which may increase the risk of cancer recurrence