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 |