Anesthetics and cancer biology: Translational evidence from perioperative modulation to drug repurposing (Review).

Authors

Ting Yang, Jiao Tang, Muhammad Saqib Mudabbar, Huan Hu, Qiang Fu, Chunlan Pu

Published in

International journal of molecular medicine. Volume 58. Issue 6. Epub Oct 09, 2026.

Abstract

Perioperative anesthesia is delivered during a brief but biologically dynamic interval in which surgical stress, inflammation, immune perturbation and tissue repair may alter the environment encountered by residual or disseminated tumor cells. Experimental studies indicate that anesthetic‑related agents can modify proliferation, apoptosis, epithelial‑mesenchymal transition, angiogenesis, immune surveillance and the tumor microenvironment. Translation to clinical benefit, however, has been inconsistent, in part because experimental models, routes and exposure schedules often differ substantially from perioperative pharmacology. Lidocaine and propofol illustrate this gap. In early breast cancer, a multicenter randomized trial reported improved 5‑year disease‑free and overall survival after preoperative peritumoral infiltration with 0.5% lidocaine, although independent confirmation is still required. By contrast, randomized comparisons of propofol‑based and volatile anesthesia, including long‑term follow‑up studies and GA‑CARES, have not demonstrated an overall‑ or disease‑free‑survival advantage for propofol. Mechanistic and perioperative biomarker studies remain informative, but these biomarkers are not validated surrogates for oncological outcomes. This review therefore evaluates anesthetic‑related interventions according to the exposure actually delivered, the level of mechanistic inference supported and the strength of clinical outcome evidence. Routine anesthetic choice should continue to follow established perioperative indications, whereas future cancer‑directed studies should align clinically achievable exposure with defined biological mechanisms, selected patient populations and clinically meaningful endpoints.

PMID:
42852614
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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