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Table 1 Effect of surgery on immune function and tumor metastasis

From: Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence

Factor

Experimental data

Clinical data

Surgery-induced stress

Increased vascularization [3]

Augmentation of angiogenesis [2]

Inadvertent dispersal of tumor cells [20]

Modification of neural, endocrine, metabolic, inflammatory, and immunologic microenvironments [1]

Detectable tumor cells in blood and peritoneal fluid after surgery associated with shorter disease-free survival in colorectal cancer [1]

Surgery causes neoplastic cells to be dislodged from primary tumor [1, 21]

Induction of angiogenesis and proliferation of distant, dormant micro-metastases in breast cancer surgery [4]

Surgery-induced angiogenesis in breast cancer [5]

Acceleration of metastasis by surgical resection of primary breast cancer [25]

Surgical manipulation

NK cell activity

Suppression of NK cell activity, dependent on extent of surgical trauma and intensity of stress response [29]

Stimulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system

Release of catecholamines and prostaglandins [30]

Laparotomy associated with a significant increase in LTR [31]

Combination of beta-antagonism and COX inhibition reduces LTR and restores NK cell function [31]

Decrease in circulating NK cell levels [32]

Decrease in dendritic cells, CTLs, and T-helper cells [32, 33] Decrease in the Th1/Th2 ratio [33]

Increase in pro-inflammatory cytokines (e.g., IFN-α, IL-6) [32]

Increased cortisol and catecholamines [32]

Magnitude of immunosuppression is proportional to degree of surgical manipulation [33]

Cell-mediated immunity

Cytokines

Others

MMPs

Promotion effect on tumor growth and pulmonary metastasis of human breast cells by surgical process [23]

Increased plasma VEGF levels induced by surgical stress [2, 23]

Decreased plasma levels in lung cancer metastasis [24]

Reduction of growth control factors endostatin and angiostatin [28]

Decrease in circulating anti-angiogenic factors angiostatin and endostatin after surgical resection of primary colorectal carcinoma [27]

Regional anesthesia combined with propofol attenuates effect of breast surgery on MMPs compared to balanced general anesthesia with opioid anesthesia [48]

Surgery induces a transient endostatin decrease in colorectal carcinoma [26]

Decrease in circulating anti-angiogenic factors angiostatin and endostatin after surgical resection of primary colorectal carcinoma coincides with increased metabolic activity of liver metastases [27]

VEGF

TGF-β

Endostatin and angiostatin

  1. NK natural killer; CTL cytotoxic T-lymphocyte; IL interleukin; Th1 T-helper 1; Th2 T-helper 2; IFN interferon; LTR lung tumor retention; COX cyclooxygenase; VEGF vascular endothelial growth factor; TGF-β tumor growth factor β; MMPs matrix metalloproteinases