Perioperative Biologic Perturbation and Cancer Surgery: Targeting the Adrenergic-Inflammatory Response and Microcirculatory Dysregulation

Many of the physiological responses that comprise the surgical stress response are known to promote cancer-signaling pathways. Tissue resection and exposure to the pharmaco-physiological stressors of anesthesia required for surgery activate local and systemic inflammatory cytokines, up-regulate cyclooxygenase with increased prostaglandin production, and increase adrenergic activity. The activation of neuro-hormonal pathways is increasingly linked with cancer propagation. Retrospective evidence suggests that the use of anesthetic techniques and adjuncts that modulate these pathways and commonly available to practicing anesthesiologists may benefit patients scheduled for cancer surgery. Minimising the inflammatory response, preventing perioperative immunosuppression, and optimizing fluid delivery may have oncological benefits (improved disease free survival, reduced postoperative complications with timely delivery of adjuvant therapies) that extend beyond enhanced postoperative recovery. This review will consider key components of local and systemic inflammatory response, relevant immune cell mediators, perioperative endothelial dysfunction, and relevant perioperative therapies specific to the care of the patient receiving cancer surgery.