TITLE:
Perioperative Clinical Interventions That Modify the Immune Response in Cancer Patients
AUTHORS:
María F. Ramírez, Johannes M. Huitink, Juan P. Cata
KEYWORDS:
Neoplasm; Surgery; Anaesthesia; Cytokines; Neoplasm Recurrence; Immune Response; Opioids; Volatile Anaesthetics
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.3,
May
9,
2013
ABSTRACT: The immune system plays a pivotal role
against cancer. The development of a successful immune response involves the
balance between the Th1 (antitumor) and Th2 (protumor) responses. Once this
balance is lost, diseases such as cancer may become apparent. Surgical stress,
volatile anaesthetics, opioids and blood transfusions are known to favour a Th2
response that manifests as immune suppression. During surgery the load of circulating malignant
cancer cells is increased
by tumour manipulation. These cancer cells can migrate and seed in distant
tissues and form metastasis. Also, some cancer patients may present with
micrometastasis that may become invasive if left untreated. Therefore, the perioperative period is a moment of
immunological vulnerability in cancer patients. A better understanding of the
factors that affect the Th1/Th2 balance may allow anaesthesiologists to
identify patients at high risk for cancer recurrence. This review describes the
perioperative interventions that can alter the Th1/Th2 balance, during the
perioperative period of oncological surgery.