单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,麻醉影响肿瘤术后转归？,麻醉影响肿瘤术后转归？,1,Surgical resection is the primary method,of treating solid tumors,metastatic disease is a leading cause of death in people with cancer,How surgery may influence tumor,？,Surgery induces the formation of,new metastatic disease,Surgery promotes the growth of,micrometastatic and residual disease,surgical resection of the tumor is,：,the end of the treatment,the beginning of the new challenge,Cancer Res,2017,77(7):1548-1552,Surgical resection is the prim,2,The battle of Immunity and tumor,Surgical resection is the primary method of treating solid tumors,metastatic disease is a leading cause of death in people with cancer,Cancer Res,2017,77(7):1548-1552,How surgery may influence tumor,？,Surgery induces the formation of new metastatic disease,Surgery promotes the growth of micrometastatic and residual disease,proliferation,apoptosis,proliferation,apoptosis,The battle of Immunity and t,3,How anesthesia may influence tumor,？,How anesthesia may influence t,4,Eur J Pharmacol,2017,795:150-159.,propofol,the tumor size was measured every two days starting from the ninth day,followed for 19 days,Eur J Pharmacol,2017,795:150,5,Mechanism,Tumour Biol,2015,36(11):8259-8266,.,MechanismTumour Biol,2015,36,6,Mechanism,Tumour Biol,2015,36(11):8259-8266,.,Mechanism Tumour Biol,2015,3,7,Mechanism,Tumour Biol,2015,36(11):8259-8266,.,MechanismTumour Biol,2015,36,8,Ketamine,The ketamine group had significantly more,metastases than each of the control groups,ketamine group,：,ketamine(80 mg/kg,，,iP),Anesth Analg,2003,97(5):1331-1339.,Anesthesia lasted for an hour and was in-,duced 5 h before IV inoculation with tumor,cells.,KetamineThe ketamine group had,9,volatile anesthetics,Anesthesiology,2016,125(2):399-411.,volatile anesthetics Anesthesi,10,3,316 patients,（,2010-2013,）,remained in the INHA group and 3,714 in the TIVA group,1-yr survival,：,TIVA 94.1%,INHA 87.9%,Anesthesiology,2016,124(1):69-79.,Mortality was approximately 50%greater with volatile than with IV anesthesia,3,316 patients（2010-2013）rema,11,Br J Pharmacol,2017,Overview of the immunosuppressive effects of morphine.,opioids,Br J Pharmacol,2017 Overvie,12,Differential effects of opioids on the immune system,Anesth Analg,2016,Differential effects of opioid,13,Recent Results Cancer Res,2013,191:67-93.,NSAIDs,Recent Results Cancer Res,20,14,Oncogene,2017,The effect of COX-2 inhibitors,Oncogene,2017 The effect of,15,.,Conclusion,：,Standard dosing of the celecoxib slightly reduced perioperative COX activity during cancer surgery.,Can J Anaesth,2017,64(5):497-505.,32 patients,who were to undergo major,intracavity cancer,surgery were enrolled,The treatment group received 400 mg,celecoxib,preoperatively followed by five 200 mg 12-hourly doses.,The control group received no anti-inflammatory agents,.Conclusion：Standard dosing of,16,The direct effect,of,Local anesthetics,on tumor,J Clin Anesth,2015,27(3):262-272.,Stimulation,：,Apoptosis,Inhibition,：,Migration,invasiveness,Inhibition,：,Proliferation,Inhibition,：,Substance P,NK1r,The direct effect of Local an,17,Int J Cancer,2015,137(12):2774-2784.,The,in,direct effect,of,Local anesthetics,on tumor,afferent sensory impulse blockade and enhanced pain relief.,plasma concentrations of mediators are,reduced with CMI being better preserved,inflammation facilitates the whole spectrum of tumor development;from initiation through to metastasis,LA potentially decreasing the likelihood of cancer recurrence after surgery,LA is more effective at managing neuro-pathic pain that can be caused by tumor invasion or as a result of surgery itself,Int J Cancer,2015,137(12):2,18,Med Sci Monit,2016,22:2379-2385.,No obvious difference was detected between the 2 anesthesia groups,but younger patients may benefit from epidural anesthesia.,Med Sci Monit,2016,22:2379-2,19,patients who received epidural anaesthesia,(EA)would exhibit decreases in VEGF-C,TGF-,and IL-6 and an increase in IL-10 compared with patients who received general anaesthesia(GA),Br J Anaesth,2014,113(S 1)i49-55,patients who received epidural,20,Anesth Analg,2017,124(5):1381.,How anesthesia may influence tumor,？,volatile anesthetics and opioids can impair immune function and promote tumor development,propofol,local anesthetic and NSAID,s may be beneficial to reduce tumor recurrence and improve the cancer outcome,Anesth Analg,2017,124(5):13,21,What can I do,？,We address the role of perioperative factors,including anesthesia,transfusions,hypothermia,and postoperative complications,as probable deleterious factors contributing to early recurrence.,Cancer-associated pain,whether acute or chronic,requires treatment.Pain itself promotes cancer progression and analgesia must not be compromised.,There is no drug or anesthetic methodology that is categorically beneficial or harmful in patients presenting for cancer surgery.Cancer patients should receive best practice anaesthetic techniques in accordance with their own decisions and como