Anaesthetic interventions and long-term tumour recurrence
Mené dans 8 pays sur 2 108 patientes atteintes d'un cancer du sein, cet essai randomisé compare l'effet, du point de vue de la récidive locale ou métastatique, d'une anesthésie locorégionale (par bloc paravertébral et propofol) et d'une anesthésie générale (par sévoflurane et opioïdes) avant un traitement chirurgical à visée curative (durée médiane de suivi : 36 mois)
Surgery is a major component of the treatment plan for patients with potentially curable solid tumours. The efficacy of surgery in preventing tumour recurrence is affected by several factors, including disease stage, adequacy of surgical tumour resection, and intrinsic antitumour immunity. Although adequate intraoperative and postoperative pain control is an important component of optimum recovery after surgery, pain might also be another factor affecting the risk of long-term recurrence after cancer surgery. Specifically, pain has both direct and indirect (ie, mediated via the surgical stress response) immunosuppressive effects, as do some commonly used pain-control drugs (eg, inhaled general anaesthetics and opioids).
The Lancet , commentaire, 2018