EURO-PERISCOPE

ABSTRACT

Cancer remains one of the principal causes of mortality in Europe, usually attributable to metastasis, rather than the primary tumour itself. Surgery is the primary treatment of many tumour types, but minimal residual disease, i.e. scattered micro metastasis during surgery, is usually inevitable. Whether this results in clinical recurrence depends on the balance between conflicting forces at work in the perioperative period, including the patient’s immune function, the surgical stress response, postoperative pain, and direct effects of anaesthetic and analgesic drugs and techniques which may either promote or inhibit tumour cell survival.

Since a retrospective clinical study found an association between improved survival after breast cancer with a combined propofol-regional anaesthetic technique, compared with standard general anaesthesia and opioid analgesia, the hypothesis that anaesthetic, analgesic or other perioperative interventions during primary cancer surgery could influence recurrence or metastasis has gained worldwide traction, topping a research priority setting exercise. Conflicting results from multiple retrospective studies in various cancers and the huge potential impact of a positive outcome warrant definitive evidence from prospective, randomised trials. A few have started, but are necessarily protracted, requiring long term patient follow-up.

Many laboratory and translational studies, including using serum of patients randomised to a clinical trial have also produced findings suggestive of a signal that anaesthetic-analgesic technique during cancer surgery might have an hitherto unrecognised effect on recurrence or metastasis. This COST Action will enable co-ordination of activity among a network of active European researchers in this exciting new field of research.