1. Does anaesthesia affect patient outcome in malignant disease?
Local anaesthetics affect Src tyrosine protein kinase activation, which will block leucocyte binding to malignant cells, as well as adhesion to the endothelium. The endothelial barrier will stay intact, and the migratory abilities of the malignant cells will be diminished, as well as their proliferation (Votta-Velis EG, et al. Acta Anaesthesiol Scand 2013;57: ). This may explain the example on lung metastasis from lidocaine in a breast cancer model (slide 2).
Opposite effects on the immune system by different hypnotics may result in differences in survival after cancer surgery, as indicated in two retrospective patient studies (Enlund M, et al. Ups J Med Sci. 2014;119: and Wigmore TJ, et al. Anesthesiology 2016;124:69-79). Randomised, controlled trials are on their way (slide 3).
Mats Enlund
Uppsala University
Centre for Clinical Research, Västerås

2. SL Sevoflurane & Lidocaine
S Sevoflurane
P=0.006
Dr Mark Johnson
Research Fellow in Anaesthesia
Mater Misercordiae University Hospital & University College Dublin

3. Ongoing studies propofol vs inhalational
Sponsor
Acronym
Randomisation
Outcome
Cancer-localisation N
Start
Close
Stony Brook University, New York
GA-CARES
TIVA vs Inhal.
All-cause mortality, 2 yr
Mixed
2000
2017
2020
Peking University First Hospital, Beijing
Propofol vs sevoflurane
Survival rate, 1, 2 och 3 yr
1200
2015
CKF-Västerås/
Uppsala University
CAN
Survival rate, 1 och 5 yr
Breast and colo-rectal
8000
2013
2022
ClinicalTrials.gov (September 1, 2017)