Current Understanding on Perioperative Management in Lung Cancer: Implications for Anesthetic Considerations

Abstract

Narcotic drugs are often used to treat perioperative pain for patients with lung cancer. However, anesthetic management and narcotic substance use may have significant impacts on patients with lung cancer, including anti-cancer or promoting cancer effects. In this study, we summarize the effects of anesthetic management and its related substances on lung cancer. An evidence-based review of the influence of anesthetic techniques and narcotic substances used on lung cancer was performed. The effects of perioperative pain management and the method of choosing anesthesia for patients with lung cancer were explored. Different management techniques of anesthesia have been indicated to suppress both cell-mediated immunity and humoral immunity and have effects on the recurrence and metastasis of lung cancer. Evidence suggests that the effects of narcotic substances used on lung cancer were still inconsistent. However, the mechanisms by which anesthetics and analgesics inhibit the tumor are complicated. Perioperative management leads to decreased immunity in patients with lung cancer, which to some extent contributes to recurrence and metastasis. Various narcotic substances used may modulate signal pathways, including the mitochondrial pathway, and appear to exert different effects on the recurrence and metastasis of lung cancer. The anesthesiologists should consider these effects on perioperative management with lung cancer.

Keywords:

• narcotic substance use
• anesthetics
• lung cancer

Abbreviations

CNKI, China National Knowledge Infrastructure; TIVA, total intravenous anesthesia; NSCLC, non-small cell lung cancer; GPCRs, G protein-coupled receptors; 7TM, seven transmembrane domain; STAT3, signal transduction and activation of transcription 3; OGFR, opioid growth factor receptor; MMP, matrix metalloproteinases; EMT, epithelial-to-mesenchymal transition; HIF-2α, hypoxia-inducible factor; TNF-α, tumor necrosis factor alpha; ICAM-1, intercellular adhesion molecule 1; MAPK, mitogen-activated protein kinase; PARP, poly ADP-ribose polymerase; ERAS, enhanced recovery after surgery.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (No. 82003882), Natural Science Foundation of Liaoning Province (No. 2019-ZD-0339), Science and Technology Projects of Shenyang (No. 19-112-4-096), and Shenyang Young and Middle-aged Science and Technology Innovation Talents (No. RC200528).