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Type of anaesthesia during cancer surgery and cancer recurrence

BMJ 2011; 342 doi: (Published 29 March 2011) Cite this as: BMJ 2011;342:d1605
  1. B C H Tsui, professor1,
  2. J S Green, anaesthesiologist1
  1. 1Department of Anesthesiology and Pain Medicine, University of Alberta, Stollery Children’s Hospital/University of Alberta Hospital, Edmonton, AB, Canada T6G 2G3
  1. btsui{at}

Regional anaesthesia has short term benefits over general anaesthesia, but cancer related effects are unknown

The immune system plays an important part in regulating tumour growth and metastasis. Immunosuppression in the perioperative period has been hypothesised to promote cancer recurrence after resection of certain cancers.1 Anaesthetic strategies that protect the immune system have been suggested to guard against this effect and may reduce cancer recurrence and improve length of survival.1 In the linked study (doi:10.1136/bmj.d1491), Myles and colleagues compare long term cancer recurrence and survival of patients undergoing major abdominal surgery for cancer, who were previously randomised to receive general anaesthesia with or without epidural block for at least three postoperative days.2

This is not a new concept—research on this topic stretches back to the 1970s. Review of animal and ex vitro human studies suggests that surgical stress, pain, anxiety, and certain anaesthetic and analgesic agents can temporarily suppress individual components of the immune system during the perioperative period.1 3 Conversely, regional anaesthesia has been shown to minimise immunosuppression via its opioid sparing effect …

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