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Table 3 Effect of anesthetic agents on tumor development

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

Agent Experimental data Clinical data
 Ketamine Stimulator of lung and liver metastasis [65] Increase in lung tumor retention or lung metastasis [66]
Increase in lung tumor retention or lung metastasis [66]
Inhibition of HIF-1α activation [71]
Prevention of isoflurane-induced HIF-1α activation [71] Antitumor effect [18]
Volatile anesthetics   
 Halothane Stimulator of lung and liver metastasis [65]
Suppression of hypoxia-induced growth and metastasis of lung cancer cells [35] Increased proliferation, migration, and invasion of breast cancer cells [77]
Serum from sevoflurane/opioid anesthesia-analgesia for breast cancer surgery attenuates the inhibition of breast cancer cell proliferation [69]
Increased expression of pro-oncogenic protein markers in head and neck squamous cell carcinoma cells [70]
Isoflurane Upregulation of HIF-1α in prostate cancer cell line [71]
Increase in malignant potential of ovarian cancer cells [72]
Resistance against apoptosis via a Cav-1-dependent mechanism in cancer cells [73]
Nitrous oxide Suppression of neutrophil chemotaxis, potentially facilitating the spread of cancer [18]
Potent stimulator of lung and liver metastasis [65]
No effect on colorectal carcinoma recurrence [87]
 Morphine Promotion of tumor growth (single-dose or low dose) [81]
Involvement of MOR in tumor development [85,86,87]
Promotion of tumor growth and metastasis by MOR overexpression [85] Proangiogenic and proliferative effects in breast cancer xenografts [76, 90]
Increase in endothelial cell proliferation expressed with mu3 opioid receptor [91] Stimulation of Rho A and Src activation downstream of the VEGFR [88]
Direct effect of morphine on breast cancer cell migration via NET1 [68]
Reduction in growth of certain tumors in part through activation of p53 [82] Attenuation of MMP secretion under the control of nitric oxide system [83]
Beneficial effects on surgery-induced increases in metastasis by pre-surgical administration of morphine [93]
Protective effect against metastasis development [34]
Antitumor-like effects on colorectal cancer cells [95, 96]
No change in apoptosis rate or cell cycle distribution at clinical concentrations [97]
Increase in MOR expression in patients with non-small cell lung cancer [86] and metastatic lung cancer [84]
A possible adjuvant therapy of MNTX for patients with advanced cancer [88]
Intraoperative opioid use is associated with decreased OS in stage I but not stage II-III NSCLC patients [94]
 COX-2 inhibitor Antitumor and antiangiogenic properties [99]
Reduction of ketamine-induced lung metastasis [81]
Reduced risk of breast and colorectal cancer [100, 101]
Use of COX-2 inhibitor was associated with one-fifth reduction in breast cancer recurrence [102]
  β-adrenergic antagonist
Local anesthetics   
Lidocaine Antitumor effect of lidocaine via the inhibition of EGF/EGFR pathway in human tongue cancer cells [105]
Apoptotic cell death by lidocaine and bupivacaine in breast cancer cells [106]
Demethylation of DNA in breast cancer cell lines [108]
Inhibition of cancer cell invasion [109]
Reduced proliferation of mesenchymal stem cells [104]
Decreased metastatic progression in breast tumor cells [107] Reduced proliferation of MSCs [104]
No change in apoptosis rate or cell cycle distribution at clinical concentrations [97]
  1. HIF- hypoxia inducible factor-1α; MOR Mu-opioid receptor; VEGFR vascular endothelial growth factor receptor; MNTX methylnaltrexone; MMP matrix metalloproteinase; NSCLC non-small cell lung cancer; COX-2 cyclooxygenase-2; EGF epidermal growth factor; EGFR epidermal growth factor receptor; MSCs mesenchymal stem cells