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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
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]
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