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Tipping the Scales for Cancer Surgery Outcomes: Anesthetic Influences on Cancer Progression

Nathan, Naveen MD

doi: 10.1213/ANE.0000000000002082
Infographics: Infographic

Northwestern University Feinberg School of Medicine (

The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of Medicine (

Illustration by Naveen Nathan, MD.

This infographic visually captures our current suppositions of anesthetic drug effects on tumor recurrence after cancer surgery. Amelioration of the surgical neuroendocrine stress response with preservation of natural killer cell activity is understood to promote a greater chance of disease free survival. This may in part be due to natural killer cell neutralization of residual microscopic disease. A host of drug classes pose varying capabilities to this end. However, due to a variety of limitations in study design, there is no drug or anesthetic methodology that is categorically beneficial or harmful in patients presenting for cancer surgery. Further, large-scale human trials are warranted.1

COX indicates cyclooxygenase; EGF, epidermal growth factor; HIF-1a, hypoxia-inducible factor-1a; MAPK, mitogen-activated protein kinase; NK, natural killer; TNF alpha, tumor necrosis factor alpha.

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1. Sekandarzad MW, van Zundert AAJ, Lirk PB, Doornebal CW, Hollmann MW. Perioperative anesthesia care and tumor progression. Anesth Analg. 2017;124:1697–1708.
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