Cancer recurrence and metastasis remain critical challenges following surgical resection, influenced by complex perioperative mechanisms. This review explores how surgical stress triggers systemic changes, such as neuroendocrine responses, immune suppression, and inflammation, which promote the dissemination of residual cancer cells and circulating tumor cells. Key mechanisms, such as epithelial–mesenchymal transition and angiogenesis, further enhance metastasis, while hypoxia-inducible factors and inflammatory responses create a microenvironment conducive to tumor progression. Anesthetic agents and techniques modulate these mechanisms in distinct ways. Inhaled anesthetics, such as sevoflurane, may suppress immune function by increasing catecholamines and cytokines, thereby promoting cancer progression. In contrast, propofol-based total intravenous anesthesia mitigates stress responses and preserves natural killer cell activity, supporting immune function. Opioids suppress immune surveillance and promote angiogenesis through the activation of the mu-opioid receptor. Opioid-sparing strategies using NSAIDs show potential in preserving immune function and reducing recurrence risk. Regional anesthesia offers benefits by reducing systemic stress and immune suppression, though the clinical outcomes remain inconsistent. Additionally, dexmedetomidine and ketamine exhibit dual effects, both enhancing and inhibiting tumor progression depending on the dosage and context. This review emphasizes the importance of individualized anesthetic strategies to optimize long-term cancer outcomes. While retrospective studies suggest potential benefits of propofol-based total intravenous anesthesia and regional anesthesia, further large-scale trials are essential to establish the definitive role of anesthetic management in cancer recurrence and survival.
癌症复发与转移仍是外科切除术后面临的关键挑战，其发生受到复杂围手术期机制的影响。本综述探讨手术应激如何引发神经内分泌反应、免疫抑制及炎症等系统性改变，从而促进残留癌细胞与循环肿瘤细胞的扩散。上皮-间质转化和血管生成等关键机制进一步加剧转移进程，而缺氧诱导因子与炎症反应则共同营造有利于肿瘤进展的微环境。麻醉药物与技术以不同方式调控这些机制：吸入麻醉药（如七氟醚）可能通过增加儿茶酚胺和细胞因子抑制免疫功能，进而促进癌症进展；相比之下，基于丙泊酚的全凭静脉麻醉可减轻应激反应并维持自然杀伤细胞活性，有助于免疫功能保护。阿片类药物通过激活μ-阿片受体抑制免疫监视并促进血管生成，而采用非甾体抗炎药的阿片节俭策略在维持免疫功能、降低复发风险方面展现出潜力。区域麻醉通过减轻全身性应激与免疫抑制发挥积极作用，但其临床结局仍存在不一致性。此外，右美托咪定与氯胺酮表现出双重效应，其促进或抑制肿瘤进展的作用取决于剂量与具体情境。本综述强调个体化麻醉策略对优化癌症远期结局的重要性。尽管回顾性研究提示丙泊酚全凭静脉麻醉与区域麻醉可能具有临床获益，但仍需开展大规模试验以明确麻醉管理在癌症复发与生存中的确切作用。
Anesthetic Approaches and Their Impact on Cancer Recurrence and Metastasis: A Comprehensive Review
肿瘤(癌症)患者之家