REVIEW article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1558652
The impact of perioperative anesthesia management-induced immunosuppression on postoperative cancer recurrence and metastasis: a narrative review
Provisionally accepted
- 1School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong Province, China., Weifang, China
- 2Weifang Hospital of Traditional Chinese Medicine, Shandong Second Medical University, Weifang, Shandong Province, China., Weifang, China
- 3Department of Anesthesiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China., Jinan, Shandong Province, China
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Perioperative anesthesia management not only ensures safe and smooth surgery, but its potential immunomodulatory function has also triggered close attention from many researchers. Surgical/anesthetic drugs can cause immunosuppression characterized by decreased natural killer (NK) cell activity, suppression of helper T cell (Th1) function, and imbalance of pro-inflammatory factors. The immunosuppressive microenvironment allows residual cancer cells to evade recognition by the host immune system, resulting in proliferation and distant metastasis. Several retrospective studies have demonstrated an association between cancer patients receiving inhalation anesthesia and reduced recurrence-free survival compared with cancer patients receiving propofol anesthesia. Regional anesthesia techniques may reduce the risk of postoperative recurrence of certain cancers by reducing the amount of systemic opioids and mitigating surgical stress, which in turn may reduce the risk of recurrence after surgery. This review also discusses the effects of pain, blood transfusion, hypothermia, blood pressure, and psychological stress on postoperative metastatic recurrence and immune function in cancer patients. However, observational studies of cancer outcomes after radical surgery for many cancer types under different anesthesia techniques have reported conflicting results, and large, prospective, randomized clinical trials (RCTs) are needed to clearly optimize anesthesia strategies, and to provide new ideas for future efforts to minimize immunosuppression and improve the long-term survival of cancer patients through individualized anesthesia regimens.
Keywords: Perioperative Period, Anesthesia management, general anesthesia, regional anesthesia, cancer metastasis, cancer recurrence, Immunosuppression
Received: 14 Jan 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Teng, Yin, Shi, Zhao, Zhao and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoyong Zhao, School of Anesthesiology, Shandong Second Medical University, Weifang, Shandong Province, China., Weifang, China
Meiyan Sun, Weifang Hospital of Traditional Chinese Medicine, Shandong Second Medical University, Weifang, Shandong Province, China., Weifang, China
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