Editorial Board Members’ Collection Series: Contemporary Perioperative Concepts in Cancer Surgery

A topical collection in Current Oncology (ISSN 1718-7729). This collection belongs to the section "Surgical Oncology".

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Editors

Department of Anesthesiology and Perioperative Medicine, UTMD Anderson Cancer Center, Houston, TX, USA
Interests: oncology; opioid analgesics; perioperative care; recurrence; anesthesia
Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
Interests: abdominal surgery; radiation therapy; anesthesiology; hepatobiliary and pancreatic surgery
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Topical Collection Information

Dear Colleagues,

Cancer is a major global public health concern that affects all communities across the world. Globally, the incidence of cancer is predicted to increase by 50% by the year 2030; and during the same period, cancer-related mortality is projected to increase by 60% to 13.1 million deaths worldwide. This increasing trend in cancer-related mortality is mainly due to the increasing incidence of cancer and cancer-related mortality in the developing world and the overall increase in global population, particularly the marked increase in the population over the age of 60 years.

Of the nearly 20 million new cancer cases worldwide in 2022, over 80% of cases will need surgery, some several times, as curative resection is essential for cancer control, particularly for those with solid tumors. Given the emerging tsunami of cancer and increasing need for surgical cancer care; understanding advances in cancer biology, rapidly evolving cancer therapeutics, modern surgical techniques, and evolving patient-centered, recovery-focused perioperative care concepts is essential for anesthesiologists, perioperative clinicians, surgeons, nurses, intensivists, pain medicine clinicians and integrative medicine specialists.

The perioperative period is a pathophysiological state characterized by intense emotional and physiological (surgical) stress, pain, inflammation, immune suppression, negative nitrogen balance, and insulin resistance. The combined effect of neuro-inflammatory signaling and endocrine-metabolic effects in the perioperative period can lead to immune suppression and altered immune responses, influencing wound healing and recovery from surgery. However, these pathways are also an integral component of the inflammatory-immune responses leading to an immunosuppressive microenvironment in tumor stromal tissue, particularly in the presence of postoperative complications. Our understanding of perioperative factors that contribute to tumor spread and recurrence (from minimal residual disease, circulating tumor cells, or micro metastatic disease) is rapidly evolving with the potential to influence long-term cancer outcomes. In the surgical cancer patient, effective perioperative strategies and surgical techniques should, therefore, not only aim to provide effective analgesia and control of symptom burden, but also aim for margin free resection, minimize preventable complications and enhance functional recovery. Surgical techniques, operative approaches, and perioperative cancer therapies should also aim to attenuate the surgical stress response and positively modulate the inflammatory-immune response for improved clinical, oncological, and patient-centered outcomes.

This Topical Collection of Current Oncology titled “Contemporary Perioperative Concepts in Cancer Surgery” will address key topics of advances in cancer biology, newer cancer therapeutics, modern surgical techniques, and evolving patient-centered, recovery-focused perioperative care concepts that directly influence patient outcomes. Each of the articles is authored by international experts in the field and discusses the current understanding and practices, ongoing controversies and unanswered questions, and the direction for future studies. This exercise, we hope, will highlight the need for ongoing scientific study on key areas to further enhance perioperative and periprocedural care of our patients with cancer and cancer survivors.

Sincerely,

Prof. Dr. Vijaya Gottumukkala
Prof. Dr. Jörg Kleeff
Collection Editors

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Keywords

  • advances in cancer biology
  • modern surgical techniques
  • perioperative care
  • anesthetic technique
  • pain management
  • rehabilitative and palliative care

Published Papers (8 papers)

2024

Jump to: 2023

20 pages, 1529 KiB  
Review
Preparing for and Not Waiting for Surgery
Curr. Oncol. 2024, 31(2), 629-648; https://doi.org/10.3390/curroncol31020046 - 23 Jan 2024
Viewed by 526
Abstract
Cancer surgery is an essential treatment strategy but can disrupt patients’ physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, [...] Read more.
Cancer surgery is an essential treatment strategy but can disrupt patients’ physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, and propose the adoption of personalised prehabilitation to mitigate risk. Perioperative medicine is a growing speciality that aims to improve clinical outcome by preparing patients for the stress associated with surgery. Preparation should begin at contemplation of surgery, with universal screening for established risk factors, physical fitness, nutritional status, psychological health, and, where applicable, frailty and cognitive function. Patients at risk should undergo a formal assessment with a qualified healthcare professional which informs meaningful shared decision-making discussion and personalised prehabilitation prescription incorporating, where indicated, exercise, nutrition, psychological support, ‘surgery schools’, and referral to existing local services. The foundational principles of prehabilitation can be adapted to local context, culture, and population. Clinical services should be co-designed with all stakeholders, including patient representatives, and require careful mapping of patient pathways and use of multi-disciplinary professional input. Future research should optimise prehabilitation interventions, adopting standardised outcome measures and robust health economic evaluation. Full article
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2023

Jump to: 2024

11 pages, 1811 KiB  
Review
Post-Operative Care of the Cancer Patient: Emphasis on Functional Recovery, Rapid Rescue, and Survivorship
Curr. Oncol. 2023, 30(9), 8575-8585; https://doi.org/10.3390/curroncol30090622 - 19 Sep 2023
Viewed by 1433
Abstract
A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of [...] Read more.
A cancer diagnosis and its subsequent treatments are life-changing events, impacting the patient and their family. Treatment options available for cancer care are developing at pace, with more patients now able to achieve a cancer cure. This is achieved through the development of novel cancer treatments, surgery, and modern imaging, but also as a result of better understanding treatment/surgical trauma, rescue after complications, perioperative care, and innovative interventions like pre-habilitation, enhanced recovery, and enhanced post-operative care. With more patients living with and beyond cancer, the role of survivorship and quality of life after cancer treatment is gaining importance. The impact cancer treatments can have on patients vary, and the "scars" treatments leave are not always visible. To adequately support patients through their cancer journeys, we need to look past the short-term interactions they have with medical professionals and encourage them to consider their lives after cancer, which often is not a reflection of life before a cancer diagnosis. Full article
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16 pages, 945 KiB  
Review
Intravenous Iron Therapy to Treat Anemia in Oncology: A Mapping Review of Randomized Controlled Trials
Curr. Oncol. 2023, 30(9), 7836-7851; https://doi.org/10.3390/curroncol30090569 - 24 Aug 2023
Viewed by 2953
Abstract
Anemia is a common problem when patients present with cancer, and it can worsen during treatment. Anemia can directly impact the cognitive and physical quality of life and may impair fitness for oncological therapy. The most common cause of anemia is iron deficiency. [...] Read more.
Anemia is a common problem when patients present with cancer, and it can worsen during treatment. Anemia can directly impact the cognitive and physical quality of life and may impair fitness for oncological therapy. The most common cause of anemia is iron deficiency. Newer intravenous (IV) iron formulations offer a safe and rapidly effective treatment option. We performed a systematic mapping review of randomized controlled trials (RCTs) evaluating intravenous iron therapy in patients with cancer and anemia and their outcomes. A total of 23 RCTs were identified. The median number of patients enrolled was 104 (IQR: 60–134). A total of 5 were focused on surgical outcomes (4 preoperative, 1 postoperative), and 15 were in adjuvant therapies for a variety of tumor types (breast, colorectal, lung, gynecological, myeloid, and lymphomas), 10 of which were in combination with erythropoietin-stimulating agents (ESAs) therapy, 2 in radiotherapy, and 1 in palliative care. Overall, the studies reported that the use of IV iron increased hemoglobin concentration and decreased transfusion rates during different cancer treatment regimes. IV iron can be administered safely throughout the cancer treatment pathway from primary surgery to the palliative setting. More studies are needed to demonstrate net clinical outcomes. Full article
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16 pages, 3786 KiB  
Review
Novel Cellular and Immunotherapy: Toxicities and Perioperative Implications
Curr. Oncol. 2023, 30(8), 7638-7653; https://doi.org/10.3390/curroncol30080554 - 16 Aug 2023
Viewed by 1159
Abstract
Targeted cellular and immunotherapies have welcomed a new chapter in multi-modal cancer therapy. These agents harness our innate immune system and destroy malignant cells in a precise way as compared with “legacy” chemotherapeutic agents that largely rely on abolishing cell division. New therapies [...] Read more.
Targeted cellular and immunotherapies have welcomed a new chapter in multi-modal cancer therapy. These agents harness our innate immune system and destroy malignant cells in a precise way as compared with “legacy” chemotherapeutic agents that largely rely on abolishing cell division. New therapies can augment the T-cell recognition of tumor antigens and effectively prevent tumor cells from their historically successful ability to evade immune recognition. These novel agents cause acute and chronic toxicities to a variety of organ systems (enteritis, pneumonitis, hypophysitis, and hepatitis), and this may masquerade as other chronic illnesses or paraneoplastic effects. As the perioperative footprint of cancer patients increases, it is essential that perioperative providers—anesthesiologists, surgeons, nurse anesthetists, and inpatient hospital medicine providers—be up to date on the physiologic mechanisms that underlie these new therapies as well as their acute and subacute toxicity profiles. Immunotherapy toxicity can significantly impact perioperative morbidity as well as influence perioperative management, such as prophylaxis for adrenal insufficiency, preoperative pulmonary assessment, and screening for thyroid dysfunction, among others. Full article
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28 pages, 819 KiB  
Review
Immunotherapy during the Immediate Perioperative Period: A Promising Approach against Metastatic Disease
Curr. Oncol. 2023, 30(8), 7450-7477; https://doi.org/10.3390/curroncol30080540 - 07 Aug 2023
Cited by 1 | Viewed by 1676
Abstract
Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual [...] Read more.
Tumor excision is a necessary life-saving procedure in most solid cancers. However, surgery and the days before and following it, known as the immediate perioperative period (IPP), entail numerous prometastatic processes, including the suppression of antimetastatic immunity and direct stimulation of minimal residual disease (MRD). Thus, the IPP is pivotal in determining long-term cancer outcomes, presenting a short window of opportunity to circumvent perioperative risk factors by employing several therapeutic approaches, including immunotherapy. Nevertheless, immunotherapy is rarely examined or implemented during this short timeframe, due to both established and hypothetical contraindications to surgery. Herein, we analyze how various aspects of the IPP promote immunosuppression and progression of MRD, and how potential IPP application of immunotherapy may interact with these deleterious processes. We discuss the feasibility and safety of different immunotherapies during the IPP with a focus on the latest approaches of immune checkpoint inhibition. Last, we address the few past and ongoing clinical trials that exploit the IPP timeframe for anticancer immunotherapy. Accordingly, we suggest that several specific immunotherapies can be safely and successfully applied during the IPP, alone or with supporting interventions, which may improve patients’ resistance to MRD and overall survival. Full article
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21 pages, 756 KiB  
Review
Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques
Curr. Oncol. 2023, 30(7), 6838-6858; https://doi.org/10.3390/curroncol30070500 - 18 Jul 2023
Cited by 4 | Viewed by 4844
Abstract
Pain is frequently reported during cancer disease, and it still remains poorly controlled in 40% of patients. Recent developments in oncology have helped to better control pain. Targeted treatments may cure cancer disease and significantly increase survival. Therefore, a novel population of patients [...] Read more.
Pain is frequently reported during cancer disease, and it still remains poorly controlled in 40% of patients. Recent developments in oncology have helped to better control pain. Targeted treatments may cure cancer disease and significantly increase survival. Therefore, a novel population of patients (cancer survivors) has emerged, also enduring chronic pain (27.6% moderate to severe pain). The present review discusses the different options currently available to manage pain in (former) cancer patients in light of progress made in the last decade. Major progress in the field includes the recent development of a chronic cancer pain taxonomy now included in the International Classification of Diseases (ICD-11) and the update of the WHO analgesic ladder. Until recently, cancer pain management has mostly relied on pharmacotherapy, with opioids being considered as the mainstay. The opioids crisis has prompted the reassessment of opioids use in cancer patients and survivors. This review focuses on the current utilization of opioids, the neuropathic pain component often neglected, and the techniques and non-pharmacological strategies available which help to personalize patient treatment. Cancer pain management is now closer to the management of chronic non-cancer pain, i.e., “an integrative and supportive pain care” aiming to improve patient’s quality of life. Full article
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13 pages, 544 KiB  
Review
Anaesthetic Techniques and Strategies: Do They Influence Oncological Outcomes?
Curr. Oncol. 2023, 30(6), 5309-5321; https://doi.org/10.3390/curroncol30060403 - 26 May 2023
Cited by 1 | Viewed by 2042
Abstract
Background: With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term [...] Read more.
Background: With the global disease burden of cancer increasing, and with at least 60% of cancer patients requiring surgery and, hence, anaesthesia over their disease course, the question of whether anaesthetic and analgesia techniques during primary cancer resection surgery might influence long term oncological outcomes assumes high priority. Methods: We searched the available literature linking anaesthetic-analgesic techniques and strategies during tumour resection surgery to oncological outcomes and synthesised this narrative review, predominantly using studies published since 2019. Current evidence is presented around opioids, regional anaesthesia, propofol total intravenous anaesthesia (TIVA) and volatile anaesthesia, dexamethasone, dexmedetomidine, non-steroidal anti-inflammatory medications and beta-blockers. Conclusions: The research base in onco-anaesthesia is expanding. There continue to be few sufficiently powered RCTs, which are necessary to confirm a causal link between any perioperative intervention and long-term oncologic outcome. In the absence of any convincing Level 1 recommending a change in practice, long-term oncologic benefit should not be part of the decision on choice of anaesthetic technique for tumour resection surgery. Full article
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10 pages, 619 KiB  
Review
Research in Perioperative Care of the Cancer Patient: Opportunities and Challenges
Curr. Oncol. 2023, 30(1), 1186-1195; https://doi.org/10.3390/curroncol30010091 - 15 Jan 2023
Cited by 1 | Viewed by 1969
Abstract
The theory that the perioperative period is critical for oncological outcomes has been a matter of extensive preclinical and clinical research. Basic science research strongly supports the notion that surgical stress, anesthetics, and analgesics influence the mechanisms of cancer progression. Hence, it is [...] Read more.
The theory that the perioperative period is critical for oncological outcomes has been a matter of extensive preclinical and clinical research. Basic science research strongly supports the notion that surgical stress, anesthetics, and analgesics influence the mechanisms of cancer progression. Hence, it is hypothesized that perioperative interventions that impact mechanisms or predictors of tumor progression can also affect patients’ survival. As a result of that hypothesis, clinical researchers have conducted many retrospective studies. However, much fewer randomized controlled trials have been performed to investigate whether surgery itself (minimally invasive versus open procedures), anesthetics (volatile anesthetics versus propofol-based anesthesia), analgesics (opioids versus opioid-free anesthesia), and blood transfusions (transfusions versus no transfusions) modify the survival of patients with cancer. Unfortunately, randomized controlled trials have failed to translate the preclinical results into clinical outcomes. In this review, I will highlight the challenges of translating basic science to clinical outcomes. We will also point out opportunities for future research. Full article
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