Blog by: Aisling Buckley, Anaesthetics Fellow, Peter Mac Callum Cancer Centre.
The perioperative period has been suggested to be a critical time where various factors may influence the presence of minimal residual cancer via alterations of the stress response. This translational study examined the effect that propofol-epidural versus sevoflurane-opioid anaesthetic technique would have on proliferation, invasion and apoptosis of LoVo colon cancer cells in vitro.
40 patients were randomised to receive either propofol target controlled infusion with a thoracic epidural at the level of T9-12 or to sevoflurane with intraoperative sufentanyl and postoperative patient controlled analgesia. Venous blood samples were taken preoperatively and 24 hours postoperatively. Both groups were similar in patient demographics and tumour stage. The ability of colon cancer cells to proliferate in the propofol-epidural patients’ serum was significantly reduced compared to the sevoflurane-opioid patients’ serum. The number of invasive colon cancer cells and cell viability ratio was significantly reduced in the propofol-epidural exposed patients’ serum compared to the sevoflurane opioid group serum. Apoptosis of colon cancer cells was significantly reduced in sevoflurane-opioid exposed patients’ serum. The neutrophil/leukocyte ratio, a marker of inflammation, was lower in patients serum who received propofol-epidural analgesia.
This interesting translational study adds to the existing literature demonstrating alterations by anaesthetic technique on cancer cell biology in vitro. It is not possible to determine from this study whether the effects noted were related to the use of epidural, the avoidance of sevoflurane or reduced opioid use in the propofol-epidural group.
The true clinical impact of these findings remains to be determined by prospective randomised controlled trials looking at the effect of anaesthetic technique on cancer recurrence.