Local Anesthetics and Recurrence after Cancer Surgery-What’s New? A Narrative Review

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist’s daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome—i.e., overall and/or recurrence-free survival—in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient’s bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

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Tocilizumab use during Covid-19 should alert an orthopaedic surgeon for the surgical management of arthroplasty patients: A narrative review

IP International Journal of Orthopaedic Rheumatology ◽

10.18231/j.ijor.2021.015 ◽

2022 ◽

Vol 7 (2) ◽

pp. 65-70

Author(s):

Gaurav Govil ◽

Lavindra Tomar ◽

Pawan Dhawan

Keyword(s):

Side Effects ◽

Perioperative Period ◽

Recovery Phase ◽

Narrative Review ◽

Orthopaedic Surgeon ◽

Surgical Patients ◽

Future Research ◽

Early Recovery ◽

Considerable Uncertainty ◽

Post Surgery

The crisis of Covid-19 has shaken the world healthcare systems. The intensive care resources to manage the medical conditions associated with Covid-19 are consistently found to be inadequate with exploration and implementation of newer treatment avenues for an early recovery. Presently, the use of Tocilizumab (TCZ) in severe to critical affection of Covid-19 is being practiced as an off-label therapy. A narrative review of present knowledge regarding TCZ pharmacology, indications of its use, and potential side effects with clinical implications for an orthopedic surgeon is presented. The article discusses the clinicopathological factors required to be monitored during the perioperative management of an orthopedic patient who may have received TCZ for Covid-19 related illness. The implications of its usage should alert the orthopaedic surgeons for future management of their arthritic surgical patients. The commonly associated side effects and complications in the post-operative phase following an arthroplasty or any orthopaedic surgery are an area of concern and considerable uncertainty. In the post-Covid-19 recovery phase, when surgeons need to plan a surgical intervention then a thorough evaluation of their Covid-19 medical management history may be warranted. Practical guidelines for the management of arthritic surgical patients have been postulated. With an unregulated increased usage of TCZ during Covid-19 management, an orthopaedic surgeon should worry and needs to be aware of the possible consequences in the perioperative period for the post-surgery management. Future research to gain more insights will confirm the implied concerns.

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CytoTrack Analysis Reveals Low Presence of Circulating Tumor Cells in the Perioperative Period in Patients with Non-metastatic Colorectal Cancer

Anticancer Research ◽

10.21873/anticanres.11666 ◽

2017 ◽

Vol 37 (6) ◽

Cited By ~ 1

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Perioperative Period

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Detection of circulating tumor cells in peripheral blood of patients who underwent lung cancer surgery

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.7564 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 7564-7564

Author(s):

T. Hirata ◽

K. Takenaka ◽

E. Nakayama ◽

M. Sonobe ◽

F. Chen ◽

...

Keyword(s):

Lung Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Peripheral Blood ◽

Lung Cancer Surgery ◽

Cancer Surgery

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Morphinebut not piritramide-based postoperative analgesia negatively influences levels of circulating tumor cells and patientsʼ survival following colorectal cancer surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-201406001-00661 ◽

2014 ◽

Vol 31 ◽

pp. 229

Author(s):

P. Prasil ◽

E. Berta ◽

J. Srovnal ◽

T. Gabrhelik ◽

M. Adamus ◽

...

Keyword(s):

Colorectal Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Postoperative Analgesia ◽

Cancer Surgery ◽

Colorectal Cancer Surgery

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Abstract B41: Piritramide analgesia reduces CEA mRNA-positive circulating tumor cells’ presence compared to morphine and epidural analgesia following radical colon cancer surgery

10.1158/1557-3265.liqbiop20-b41 ◽

2020 ◽

Author(s):

Josef Srovnal ◽

Emil Berta ◽

Alona Rehulkova ◽

Monika Vidlarova ◽

Petr Prasil ◽

...

Keyword(s):

Colon Cancer ◽

Epidural Analgesia ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Cancer Surgery ◽

Colon Cancer Surgery ◽

Cea Mrna

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Circulating tumor cells detection in tumor draining vein of breast cancer patients

Scientific Reports ◽

10.1038/s41598-019-54839-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Masaya Hattori ◽

Hayao Nakanishi ◽

Mayumi Yoshimura ◽

Madoka Iwase ◽

Akiyo Yoshimura ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Liquid Biopsy ◽

Perioperative Period ◽

Complete Response ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Alternative Sources

AbstractCirculating tumor cells (CTCs) in tumor draining vein blood (DB) are potential sources for liquid biopsy. However, the identification of CTCs in DB of breast cancer has not been attempted. In this study, we investigated the feasibility of CTC detection in DB of breast cancer patients using a newly developed filtration-based microfluidic CTC detection device. Samples of peripheral vein blood (PB) and DB drawn from the lateral thoracic vein of the resected breast tissue were collected during the perioperative period. We investigated 41 breast cancer patients who underwent breast surgery with axillary lymph node dissection. DB was successfully collected in 36 patients (87.8%), with a mean amount of 0.85 ml. CTCs were detected in 58.3% of PB samples and 80.6% of DB samples. DB had significant higher number of CTCs compared with PB (p < 0.001). CTCs were detected in 75.0% of DB samples and 50.0% of PB samples from patients achieving pathological complete response after neoadjuvant chemotherapy. These results suggest that abundant CTCs are released into the DB of breast cancer patients, indicating that CTCs in DB would be alternative sources for liquid biopsy and potential indicators for monitoring of treatment response and prognosis in breast cancer patients.

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Does lung cancer surgery cause circulating tumor cells?—A multicenter, prospective study

Journal of Thoracic Disease ◽

10.21037/jtd.2017.07.33 ◽

2017 ◽

Vol 9 (8) ◽

pp. 2419-2426 ◽

Cited By ~ 8

Author(s):

Noriyuki Matsutani ◽

Noriyoshi Sawabata ◽

Masafumi Yamaguchi ◽

Tetsukan Woo ◽

Yujin Kudo ◽

...

Keyword(s):

Lung Cancer ◽

Prospective Study ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Lung Cancer Surgery ◽

Cancer Surgery ◽

Multicenter Prospective Study

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Detection and clinical significance of circulating tumor cells in colorectal cancer

Biomarker Research ◽

10.1186/s40364-021-00326-4 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Miao Jiang ◽

Shuiling Jin ◽

Jinming Han ◽

Tong Li ◽

Jianxiang Shi ◽

...

Keyword(s):

Colorectal Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Liquid Biopsy ◽

Histopathological Examination ◽

Peripheral Circulation ◽

Future Research ◽

Dynamic Changes ◽

Primary Tumors ◽

Invasive Method

AbstractHistopathological examination (biopsy) is the “gold standard” for the diagnosis of colorectal cancer (CRC). However, biopsy is an invasive method, and due to the temporal and spatial heterogeneity of the tumor, a single biopsy cannot reveal the comprehensive biological characteristics and dynamic changes of the tumor. Therefore, there is a need for new biomarkers to improve CRC diagnosis and to monitor and treat CRC patients. Numerous studies have shown that “liquid biopsy” is a promising minimally invasive method for early CRC detection. A liquid biopsy mainly samples circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), microRNA (miRNA) and extracellular vesicles (EVs). CTCs are malignant cells that are shed from the primary tumors and/or metastases into the peripheral circulation. CTCs carry information on both primary tumors and metastases that can reflect dynamic changes in tumors in a timely manner. As a promising biomarker, CTCs can be used for early disease detection, treatment response and disease progression evaluation, disease mechanism elucidation, and therapeutic target identification for drug development. This review will discuss currently available technologies for plasma CTC isolation and detection, their utility in the management of CRC patients and future research directions.

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