Anesthesia and Cancer: Friend or Foe?

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Background

Surgical tumor excision remains the gold standard treatment for accessible solid cancers. However, neoplastic resection can lead to cancer cell intravasation and systemic dissemination impacting on postoperative metastatic spread and tumor recurrence. Moreover, various effects induced by onco-surgery such as a rise in glucocorticoid levels, an increase in angiogenesis growth factor availability and local inflammatory responses can hamper anti-tumoral immune response, foster tumor growth and negatively influence disease progression. 
In the past decade, preclinical data and retrospective clinical studies suggested that the use of anesthetic agents during tumor surgery may significantly impact on long-term therapeutic outcome. However, depending on the type of anesthetic agent and the anesthetic protocols employed, both pro- or anti-tumoral effects have been reported and the impact on patient survival remains controversial. Indeed, results from preclinical studies elucidating molecular mechanisms effects of especially opioids and volatile agents stay conflicting and of clinical data is limited to retrospective studies and often hampered by confusion bias. Altogether there is currently insufficient evidence for establishing guidelines on the use of specific anesthetic agents or regimens in onco-surgery.
In this Research Topic, we welcome authors to gather available evidence on therapeutic effects after local, regional and general anesthesia employment from prospective or retrospective clinical trials or case studies with the hope to gaining further insight into the complex role of anesthesia in anticancer therapy. 
In fine, we would like to obtain an overview on the impact of currently employed anesthesia on cancer cell survival, proliferation and migration as well as immune responses and therapeutic outcome. We further aim to summarize anesthesia-induced molecular mechanisms and cellular signaling pathways that affect tumor angiogenesis, cancer metabolism and cancer immunity. We also aim to describe technological innovations and methodological advances that are employed to investigate anesthesia-specific effects on therapeutic outcome. Clinical research manuscripts should compare the use of anesthetic agents and/or regimens and describe effects on overall survival and/or recurrence-free survival. In addition, we are interested in preclinical research studies that investigate molecular mechanisms and describe technological breakthroughs. Finally, translational research on the interplay between anesthetics and conventional antitumoral therapies, especially immunotherapy, is highly encouraged.

Keywords: anesthesia, cancer, surgery, immunology, chemotherapy, cell death

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