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Opioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery?

Connolly, Cara; Buggy, Donal J.

Current Opinion in Anaesthesiology: August 2016 - Volume 29 - Issue 4 - p 468–474
doi: 10.1097/ACO.0000000000000360
DRUGS IN ANESTHESIA: Edited by Jürgen Schüttler

Purpose of review Cancer is now one of the leading causes of death worldwide, and excisional surgery is an essential treatment for the four most common adult cancers. Opioids remain the most commonly prescribed analgesics in the perioperative period of cancer surgery, yet the question of whether opioids could influence recurrence or metastasis remains unanswered.

Recent findings In-vitro cell culture, live animal models, and retrospective clinical reviews investigating the effects of opioids on outcomes after cancer surgery have yielded conflicting results, with findings ranging from deleterious, null to potentially protective effects.

Summary Prospective randomized trials are required to investigate this important topic further. Several are currently ongoing. Until the results of these are available for scrutiny, there is currently insufficient evidence to recommend any changes to current clinical practice. Opioids continue to play an important role in the perioperative period.

aDepartment Anaesthesia, Mater Misericordiae University Hospital, School of Medicine, University College Dublin, Dublin, Ireland

bOutcomes Research, Cleveland Clinic, Ohio, USA

Correspondence to Cara Connolly, MB, BCh, BAO, LRCP&SI, MSc, FCAI, Mater Misericordiae University Hospital, Dublin, Ireland. E-mail:

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