Onco-anaesthesia: From theory to practice

Surgery is the most common treatment for various solid tumours. Oncological strategies, which are mandatory for remission or reconstruction, present specific procedures for each organ. Often combined with conventional or targeted therapies fostering major side effects, surgery is paradoxically immunosuppressive. Patients also often present individual features such as cardiovascular or respiratory risk factors, addiction, difficult airway or chronic pain, which may require the implementation of a prehabilitation plan. Inflammation, pain and glucocorticoid stress decrease the antitumor immune response. Moreover, tumour manipulation by surgeons promotes cancer cell migration and recurrence. It would be advisable to favour anticancer procedures strengthening the immune system and controlling development and dissemination of residual cancer cells. Minimally invasive surgery decreases the inflammatory process and several agents increase the activity of natural killer cells for instance. Preclinical studies underlying mechanisms by which anaesthetics may possess immunomodulatory properties suggest that anaesthetic protocols may impact oncological prognosis. Better knowledge of the features of anticancer treatments, management reducing perioperative immunosuppressive factors and promotion of antitumoural agents are advised to optimise remission and prevent relapses. A specific teaching course on onco-anaesthesia could sustain the acquisition of relevant competences in this new sub- specialty.