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Review
. 2022 May 28;14(11):2684.
doi: 10.3390/cancers14112684.

Pancreatic Cancer and Microenvironments: Implications of Anesthesia

Hou-Chuan Lai  1 , Yi-Wei Kuo  2 , Yi-Hsuan Huang  1 , Shun-Ming Chan  1 , Kuang-I Cheng  2   3 , Zhi-Fu Wu  1   2   3   4
Affiliations
Review

Pancreatic Cancer and Microenvironments: Implications of Anesthesia

Hou-Chuan Lai et al. Cancers (Basel). .

Abstract

Pancreatic malignancy is a lethal neoplasm, as well as one of the leading causes of cancer-associated mortality, having a 5-year overall survival rate of less than 10%. The average life expectancy of patients with advanced pancreatic cancer does not exceed six months. Although surgical excision is a favorable modality for long-term survival of pancreatic neoplasm, metastasis is initially identified in nearly 80% of the patients by the time of diagnosis, making the development of therapeutic policy for pancreatic cancer extremely daunting. Emerging evidence shows that pancreatic neoplastic cells interact intimately with a complicated microenvironment that can foster drug resistance, metastasis, or relapse in pancreatic cancer. As a result, the necessity of gaining further insight should be focused on the pancreatic microenvironment contributing to cancer progression. Numerous evidence reveals that perioperative factors, including surgical manipulation and anesthetics (e.g., propofol, volatile anesthetics, local anesthetics, epidural anesthesia/analgesia, midazolam), analgesics (e.g., opioids, non-steroidal anti-inflammatory drugs, tramadol), and anesthetic adjuvants (such as ketamine and dexmedetomidine), might alter the tumor microenvironment and cancer progression by affecting perioperative inflammatory or immune responses during cancer surgery. Therefore, the anesthesiologist plays an important role in perioperative management and may affect surgical outcomes. However, the literature on the impact of anesthesia on the pancreatic cancer microenvironment and progression is limited. This review summarizes the current knowledge of the implications of anesthesia in the pancreatic microenvironment and provides future anesthetic strategies for improving pancreatic cancer survival rates.

Keywords: anesthesia; pancreatic cancer; tumor microenvironment.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Figure 1
Figure 1
Anesthesia in pancreatic microenvironments.
Figure 2
Figure 2
A theory on the balance between recurrence/metastasis-promoting and -inhibiting factors during pancreatic cancer surgery. The strength of the promoting effect relies on the extent of the pancreatic cancer surgery, and the strength of the inhibitory effect originates in the inhibiting factors selected. (A) Propofol, local anesthetics, non-steroidal anti-inflammatory drugs (NSAIDs), ketamine, and midazolam reduce pancreatic cancer recurrence/metastasis by protecting against immunosuppression; (B) Surgical stress, inhalation anesthesia, blood transfusion, hyperglycemia, and hypothermia promote pancreatic cancer recurrence/metastasis by causing immunosuppression.
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Grants and funding

This research received no external funding.