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Impact of perioperative pain management on cancer recurrence: an ASRA/ESRA special article
  1. Andres Missair1,2,
  2. Juan Pablo Cata3,
  3. Gina Votta-Velis4,
  4. Mark Johnson5,
  5. Alain Borgeat6,
  6. Mohammed Tiouririne7,
  7. Vijay Gottumukkala3,
  8. Donal Buggy5,
  9. Ricardo Vallejo8,
  10. Esther Benedetti de Marrero1,2,
  11. Dan Sessler9,
  12. Marc A Huntoon10,
  13. Jose De Andres11 and
  14. Oscar De Leon Casasola12
  1. 1 Department of Anesthesiology, Veterans Affairs Hospital, Miami, Florida, USA
  2. 2 Department of Anesthesiology, University of Miami, Miami, Florida, USA
  3. 3 Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
  5. 5 Department of Anesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
  6. 6 Department of Anesthesiology, University of Zurich, Balgrist, Switzerland
  7. 7 Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
  8. 8 Department of Anesthesiology, Illinois Wesleyan University, Bloomington, Illinois, USA
  9. 9 Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
  10. 10 Department of Anesthesiology, Virginia Commonwealth University, Richmond, Virginia, USA
  11. 11 Department of Anesthesiology, General University Hospital, Valencia, Spain
  12. 12 Department of Anesthesiology, University of Buffalo / Roswell Park Cancer Institute, Buffalo, New York, USA
  1. Correspondence to Andres Missair, Department of Anesthesiology and Pain Medicine, Veterans Affairs Hospital, Miami, FL, USA; andres.missair{at}


Cancer causes considerable suffering and 80% of advanced cancer patients experience moderate to severe pain. Surgical tumor excision remains a cornerstone of primary cancer treatment, but is also recognized as one of the greatest risk factors for metastatic spread. The perioperative period, characterized by the surgical stress response, pharmacologic-induced angiogenesis, and immunomodulation results in a physiologic environment that supports tumor spread and distant reimplantation.In the perioperative period, anesthesiologists may have a brief and uniquewindow of opportunity to modulate the unwanted consequences of the stressresponse on the immune system and minimize residual disease. This reviewdiscusses the current research on analgesic therapies and their impact ondisease progression, followed by an evidence-based evaluation of perioperativepain interventions and medications.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required

  • Provenance and peer review Not commissioned; externally peer reviewed