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Perioperative Management and Cancer Outcome
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Perioperative Management and Cancer Outcome

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 8805

Special Issue Editors

Dr. Óscar Díaz-Cambronero

E-Mail Website
Guest Editor
Department of Anaesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Interests: colorectal cancer
Dr. Daniela Ionescu

E-Mail Website
Guest Editor
Clinica Chirurgie III, Str Croitorilor, nr 19-21, 400162 Cluj-Napoca, Romania
Interests: critical care; medicine anesthesia; cancer pain; perioperative medicine; perioperative period
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The Special Issue "Perioperative Management and Cancer Outcomes" explores the crucial role of perioperative care in improving cancer treatment outcomes. This Issue aims to bring together the latest research and advancements in onco-anesthesiology, perioperative management strategies and their impact on cancer patients' prognosis.

The field of perioperative medicine in oncological patients has witnessed significant developments in recent years, recognizing the importance of comprehensive care before, during, and after surgical procedures. This Special Issue emphasizes the multidisciplinary approach required for optimal perioperative management, involving surgeons, anesthesiologists, oncologists, and other healthcare professionals.

The articles featured in this Special Issue cover various aspects of perioperative care, including preoperative risk assessment, optimization of patients' medical conditions, enhanced recovery after surgery (ERAS) protocols, pain management strategies, and postoperative follow-up. Additionally, it highlights the integration of advanced technologies and personalized medicine approaches in perioperative care to tailor treatment plans for individual patients.

By addressing these topics, the Special Issue aims to provide healthcare providers with a comprehensive understanding of perioperative management's influence on cancer treatment outcomes. The knowledge shared in this Issue can inform clinical practice, foster collaboration, and inspire further research to optimize perioperative care strategies and ultimately improve cancer patients' postoperative recovery and long-term survival rates.

Dr. Óscar Díaz-Cambronero
Dr. Daniela Ionescu
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • perioperative management
  • cancer treatment outcomes
  • onco-anesthesiology
  • preoperative risk assessment
  • enhanced recovery after surgery (ERAS)
  • pain management
  • personalized medicine

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Published Papers (5 papers)

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Research

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19 pages, 500 KiB  
Article
Splenectomy in Onco-Hematologic Patients: A Retrospective Study of Early Complications and 1-Year Mortality
by Marion Faucher, Stanislas Ravot, Loïc Barthes, Jean Manuel de Guibert, Laurent Chow-Chine, Frédéric Gonzalez, Magali Bisbal, Luca Servan, Marie Tezier, Maxime Tourret, Sylvie Cambon, Camille Pouliquen, Damien Mallet, Lam Nguyen Duong, Florence Ettori, Jacques Ewald, Marc Léone, Antoine Sannini, Jonathan Garnier and Djamel Mokart
Cancers 2025, 17(13), 2241; https://doi.org/10.3390/cancers17132241 - 4 Jul 2025
Viewed by 418
Abstract
Background: Splenectomy remains necessary in selected oncologic and hematologic indications but is associated with significant postoperative morbidity and mortality. The data on outcomes in this high-risk population remain limited, particularly in mixed cohorts. Methods: We conducted a retrospective cohort study including all [...] Read more.
Background: Splenectomy remains necessary in selected oncologic and hematologic indications but is associated with significant postoperative morbidity and mortality. The data on outcomes in this high-risk population remain limited, particularly in mixed cohorts. Methods: We conducted a retrospective cohort study including all patients undergoing splenectomy for oncologic or hematologic causes between 2009 and 2022 at a cancer referral center. The primary outcomes were the occurrence of major complications at day 90 and the 1-year all-cause mortality. Multivariate logistic regression was used to identify independent predictors. Results: Among the 8503 ICU admissions from surgical wards, 204 splenectomies were performed; 179 patients were analyzed. The median age was 64 years, and 100 patients (55.9%) were female. Splenectomy was performed for hematologic malignancies in 76 cases (42.5%) and for oncologic causes in 103 cases (57.5%). Laparotomy was used in 154 cases (86.0%), and metastasectomy was performed in 54 patients (30.2%). At day 90, 86 patients (48.0%) developed a major complication: 12 deaths (6.7%), 44 surgical complications (24.6%), and 71 episodes of sepsis (39.7%). In a multivariate analysis, weight loss (OR 3.39, 95% CI [1.32–8.70], p = 0.011), laparotomy (OR 4.38 [1.09–17.60], p = 0.038), and a higher SAPS II score (OR 1.08 per point [1.03–1.13], p = 0.003) were associated with complications, while metastasectomy was protective (OR 0.23 [0.08–0.67], p = 0.007). At one year, the mortality reached 22.4%. Independent predictors of death were sepsis at one year (OR 5.04, 95% CI [1.30–25.96], p = 0.029), the Charlson Comorbidity Index (OR 1.30 per point, 95% CI [1.04–1.68], p = 0.030), invasive mechanical ventilation (OR 14.94, 95% CI [2.83–118.93], p = 0.003), and a performance status >1 (OR 7.84, 95% CI [2.38–27.75], p < 0.001). Encapsulated bacteria were not isolated; sepsis was mainly due to Gram-negative and enterococcal organisms. Conclusions: Splenectomy in onco-hematologic patients is associated with high rates of sepsis and mortality. In addition to surgical factors, frailty, immune status, and infection independently contribute to the patients’ outcomes. These results support risk-adapted perioperative strategies and long-term infectious surveillance in immunocompromised patients. Full article
(This article belongs to the Special Issue Perioperative Management and Cancer Outcome)
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14 pages, 976 KiB  
Article
Propofol Total Intravenous Anesthesia for Pediatric Proton Radiotherapy and Its Effect on Patient Outcomes
by Pascal Owusu-Agyemang, Julie Mani, Techecia Idowu, Acsa Zavala, January Tsai, Ravish Kapoor, Olakunle Idowu, Jose Galdamez Melara, Pallavi Muraleedharan, Clara Francis, Lei Feng and Juan Cata
Cancers 2025, 17(12), 1904; https://doi.org/10.3390/cancers17121904 - 7 Jun 2025
Viewed by 527
Abstract
Background: Patient motion poses significant challenges for the accurate delivery of radiotherapy. In children undergoing proton beam therapy (PBT), up to 30 treatments under general anesthesia may be required over a period of 6 to 8 weeks. To date, the impact of this [...] Read more.
Background: Patient motion poses significant challenges for the accurate delivery of radiotherapy. In children undergoing proton beam therapy (PBT), up to 30 treatments under general anesthesia may be required over a period of 6 to 8 weeks. To date, the impact of this many iterative anesthetic exposures on patient outcomes remains unclear. Objective: The primary objective of this study was to assess the impact of iterative anesthesia with propofol-based total intravenous anesthesia (propofol-TIVA) on overall survival. The secondary objective was to assess the association between propofol-TIVA and the occurrence of an unplanned admission or emergency room visit within 30 days of treatment start. Methods: This was a retrospective study of children (≤19 years) who had undergone PBT (with or without anesthesia) for central nervous system disease. The Log-rank test and Cox proportional hazards models were used for analysis. Propensity score matching and E-value analyses were used to adjust for selection bias. Results: The average age of the 461 children included was 9.0 years (SD ± 4.9). The majority, 261/461 (56.6%), were male, and 267/461 (57.9%) had undergone PBT without anesthesia. The group who underwent PBT with propofol-TIVA were younger (4.7 years vs. 12.2 years, p < 0.001) and had higher proportions of patients with treatment interruptions (111/194 [57.2%] vs. 118/267 [44.2%], p = 0.006), chemotherapy history (64/194 [33.0%] vs. 18/267 [6.7%], p < 0.001), concurrent chemotherapy (37/194 [19.1%] vs. 27/267 [10.1%], p = 0.006), and unplanned admissions/emergency room visits (26/194 [13.4%] vs. 1/267 [0.4%], p < 0.001). Overall survival rates (propofol-TIVA vs. no anesthesia) at 1yr (94% vs. 96%), 2 years (88% vs. 90%), and 3 years (88% vs. 89%) were similar between patient groups (p = 0.558). In the multivariable analysis, PBT with propofol-TIVA was associated with increased odds of an unplanned admission/emergency room visit before (OR, 38.311; 95%CI, 5.139–285.580; p < 0.001) and after (OR, 42.012; 95% CI, 5.322–331.632; p < 0.001; E-value = 83.52) propensity score matching. Conclusions: In this retrospective study of children undergoing PBT for central nervous system disease, there was no association between anesthesia exposure with propofol-based total intravenous anesthesia and overall survival. However, PBT with propofol-based total intravenous anesthesia was associated with an increased risk of an unplanned admission/emergency room visit within 30 days of treatment start. Full article
(This article belongs to the Special Issue Perioperative Management and Cancer Outcome)
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13 pages, 1912 KiB  
Article
Exploring the Relationship Between Perioperative Inflammatory Biomarkers and Oncological Recurrence in Patients Undergoing Pulmonary Cancer Surgery
by Elena de la Fuente, Oscar Morgado, Francisco de la Gala, Elena Vara, Pilar Zuluaga, Almudena Reyes, Carlos M. Simón, Javier Hortal, Patricia Piñeiro and Ignacio Garutti
Cancers 2025, 17(7), 1159; https://doi.org/10.3390/cancers17071159 - 30 Mar 2025
Viewed by 609
Abstract
Background: Inflammation plays a crucial role in lung cancer recurrence after surgery. This study aims to investigate the relationship between lung cancer recurrence and perioperative inflammatory status, assessed in both blood and bronchoalveolar lavage (BAL) fluid. Methods: We conducted a retrospective cohort study [...] Read more.
Background: Inflammation plays a crucial role in lung cancer recurrence after surgery. This study aims to investigate the relationship between lung cancer recurrence and perioperative inflammatory status, assessed in both blood and bronchoalveolar lavage (BAL) fluid. Methods: We conducted a retrospective cohort study analyzing clinical variables, blood cytokine levels, and BAL fluid from lung cancer patients who underwent surgery. Logistic regression models were employed to predict recurrence. Results: Among 93 patients, 41.9% experienced recurrence within ten years. The logistic regression model identified vital status, tumor stage, and type of surgery as significant predictors of recurrence. Postoperatively, pro-inflammatory cytokines were elevated, particularly in patients who experienced recurrence. Higher levels of TNF-α in BAL fluid and increased IL-6 in blood correlated with recurrence. Additionally, metalloproteinases in BAL fluid exhibited distinct associations: MMP-2 was identified as a risk factor, whereas MMP-9 appeared to have a protective role. A multivariate model integrating clinical variables and inflammatory biomarkers significantly improved predictive accuracy (p < 0.0001). Discussion: Combining inflammatory biomarkers with clinical variables enhances the prediction of lung cancer recurrence after surgery. Understanding the dynamics of these biomarkers may facilitate early detection and enable more personalized treatment strategies. Full article
(This article belongs to the Special Issue Perioperative Management and Cancer Outcome)
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Review

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25 pages, 3265 KiB  
Review
Anesthetic Approaches and Their Impact on Cancer Recurrence and Metastasis: A Comprehensive Review
by Hoon Choi and Wonjung Hwang
Cancers 2024, 16(24), 4269; https://doi.org/10.3390/cancers16244269 - 22 Dec 2024
Cited by 8 | Viewed by 2979
Abstract
Cancer recurrence and metastasis remain critical challenges following surgical resection, influenced by complex perioperative mechanisms. This review explores how surgical stress triggers systemic changes, such as neuroendocrine responses, immune suppression, and inflammation, which promote the dissemination of residual cancer cells and circulating tumor [...] Read more.
Cancer recurrence and metastasis remain critical challenges following surgical resection, influenced by complex perioperative mechanisms. This review explores how surgical stress triggers systemic changes, such as neuroendocrine responses, immune suppression, and inflammation, which promote the dissemination of residual cancer cells and circulating tumor cells. Key mechanisms, such as epithelial–mesenchymal transition and angiogenesis, further enhance metastasis, while hypoxia-inducible factors and inflammatory responses create a microenvironment conducive to tumor progression. Anesthetic agents and techniques modulate these mechanisms in distinct ways. Inhaled anesthetics, such as sevoflurane, may suppress immune function by increasing catecholamines and cytokines, thereby promoting cancer progression. In contrast, propofol-based total intravenous anesthesia mitigates stress responses and preserves natural killer cell activity, supporting immune function. Opioids suppress immune surveillance and promote angiogenesis through the activation of the mu-opioid receptor. Opioid-sparing strategies using NSAIDs show potential in preserving immune function and reducing recurrence risk. Regional anesthesia offers benefits by reducing systemic stress and immune suppression, though the clinical outcomes remain inconsistent. Additionally, dexmedetomidine and ketamine exhibit dual effects, both enhancing and inhibiting tumor progression depending on the dosage and context. This review emphasizes the importance of individualized anesthetic strategies to optimize long-term cancer outcomes. While retrospective studies suggest potential benefits of propofol-based total intravenous anesthesia and regional anesthesia, further large-scale trials are essential to establish the definitive role of anesthetic management in cancer recurrence and survival. Full article
(This article belongs to the Special Issue Perioperative Management and Cancer Outcome)
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20 pages, 1063 KiB  
Review
Perioperative Management of Patients with Diabetes and Cancer: Challenges and Opportunities
by Mohamed Shouman, Michelle Brabant, Noor Rehman, Shahid Ahmed and Rabia K. Shahid
Cancers 2024, 16(16), 2821; https://doi.org/10.3390/cancers16162821 - 11 Aug 2024
Viewed by 3364
Abstract
Background: Both diabetes and cancer are major global health issues that are among the leading causes of morbidity and mortality. There is a high prevalence of diabetes among cancer patients, many of whom require a surgical procedure. This review focuses on the operative [...] Read more.
Background: Both diabetes and cancer are major global health issues that are among the leading causes of morbidity and mortality. There is a high prevalence of diabetes among cancer patients, many of whom require a surgical procedure. This review focuses on the operative complications in patients with diabetes and cancer, and the perioperative management of diabetes in cancer patients. Methodology: A literature search of articles in English—published between January 2010 and May 2024—was carried out using the databases PubMed, MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews. The search primarily focused on the operative complications in patients with diabetes and cancer, and perioperative management strategies. Results: The relationship between cancer and diabetes is complex; cancer patients have a high risk of developing diabetes, while diabetes is a risk factor for certain cancers. In addition, various cancer therapies can induce or worsen diabetes in susceptible patients. Many individuals with cancer and diabetes require surgery, and due to underlying diabetes, they may have elevated risks for operative complications. Optimal perioperative management for these patients includes managing perioperative glycemia and other comorbid illnesses, adjusting diabetic and cancer treatments, optimizing nutrition, minimizing the duration of fasting, supporting early mobilization, and providing patient education to enable self-management. Conclusions: While evidence is limited, optimal perioperative management for patients with both diabetes and cancer is necessary in order to reduce surgical complications. Future studies are needed to develop evidence-informed perioperative strategies and improve outcomes for these patients. Full article
(This article belongs to the Special Issue Perioperative Management and Cancer Outcome)
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