The Role of Perioperative Pharmacological Adjuncts in Cancer Outcomes: Beta-Adrenergic Receptor Antagonists, NSAIDs and Anti-fibrinolytics

Abstract

The perioperative period of cancer surgery and its impact on patients’ long-term cancer outcomes is of increasing research interest. The physiological changes coincident with surgery are characterized by a stress response manifesting as activation of inflammatory pathways and immunosuppression. These changes are potentially deleterious to a patient’s capacity to control residual or released tumor cells. Of particular relevance to anesthesiologists is the role of available adjuncts that may offset these changes to improve patients' recovery from surgery and their long-term cancer outcomes. Animal and human evidence indicates a potential therapeutic benefit for β-adrenergic receptor antagonists, selective cyclooxygenase inhibitors, and anti-fibrinolytics administered through the perioperative period. In addition to reducing the surgical stress response, these agents may effect the cancer-host tissue interface to reduce cancer invasion and dissemination. Future research will focus on defining the role of these agents as integral perioperative adjuncts for cancer surgery.

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Fig. 1

Notes

  1. 1.

    REACT: A phase III multicentre double-blind randomized trial of celecoxib versus placebo in primary breast cancer patients, http://www1.imperial.ac.uk/surgeryandcancer/divisionofcancer/cancer/ccb/iccg/react/.

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Acknowledgments

Jonathan G. Hiller and Marie-Odile Parat are the recipients of an Australian and New Zealand College of Anaesthetists Investigator Grant 13/002 and Project Grant 14/020, respectively. Dr. Bernhard Riedel wishes to thank Drs. Donal Buggy, Vijaya Gottumukkala, and Erica Sloan for their kind assistance in the development of this issue and the reviewing of the articles.

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This article is part of the Topical Collection on Cancer Anesthesia.

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Hiller, J.G., Parat, M. & Ben-Eliyahu, S. The Role of Perioperative Pharmacological Adjuncts in Cancer Outcomes: Beta-Adrenergic Receptor Antagonists, NSAIDs and Anti-fibrinolytics. Curr Anesthesiol Rep 5, 291–304 (2015). https://doi.org/10.1007/s40140-015-0113-x

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Keywords

  • Cancer
  • Anesthesia
  • Surgery
  • Anti-inflammatories
  • Anti-fibrinolytics
  • Celecoxib
  • β-Adrenergic receptor antagonists
  • Propranolol