Surgical resection is considered the definitive treatment for patients with solid neoplastic tumors. Recent experimental evidence, however, suggests that undergoing surgery may actually play a role—via activation of the surgical stress response—in promoting postoperative metastases. Additionally, there is a growing body of evidence to suggest that attenuation of the surgical stress response may, in fact, reduce the postoperative cancer recurrence and metastasis. One element of the surgical stress response amenable to perioperative attenuation is neuroendocrine activation by β blockade. Although initial data in animals appears promising, further research into the potential benefit of this therapeutic modality aimed at reducing postoperative cancer metastases is warranted.
Introduction
For many patients with solid tumors, surgical resection offers the best chance for a cure. Unfortunately, cancer can recur after resection and, whether locally or as a metastasis, recurrence is often devastating. The value in using all possible treatment modalities aimed at reducing cancer recurrence and metastases after surgery is obvious. Adjuvant chemotherapy and post-operative radiation are two such widely used modalities, but are there others?
There is a growing body of evidence to suggest that there may be another beneficial treatment in reducing metastases after surgery—perioperative attenuation of the surgical stress response. The stress response includes neuroendocrine activation, inflammation and activation of hypothalamic-pituitary-adrenal (HPA) axis, each of which may promote cancer cell survival and metastasis after surgery.1 Actions taken by the anesthesiologist or surgeon during the perioperative period may decrease the surgical stress response, with the theoretical benefit of reducing postoperative cancer recurrence and metastases. One such action is the perioperative administration of β blockers. This chapter is intended as a brief review of how elements of the surgical stress response may promote cancer growth and lead to metastases after surgery and of the evidence supporting the role that perioperative β blockade may play in reducing postoperative cancer recurrence and metastases.
The two main beta receptors that are targeted by beta blockers are the beta 1 receptor and the beta 2 receptor. A large number of beta 1 receptors are present on the heart and kidney cells, while the beta 2 receptor is the predominant regulator of vascular and nonvascular smooth muscles
https://www.ncbi.nlm.nih.gov/books/NBK169223/