Surgical excision of the primary tumor represents the most frequent and curative procedure for solid malignancies. Compelling evidence suggests that, despite its beneficial effects, surgery may impair immunosurveillance by triggering an immunosuppressive inflammatory stress response and favor recurrence by stimulating minimal residual disease. In addition, many factors interfere with the immune effectors before and after cancer procedures, such as malnutrition, anemia, or subsequent transfusion. Thus, the perioperative period plays a key role in determining oncological outcomes and represents a short phase to circumvent anesthetic and surgical deleterious factors by supporting the immune system through the use of synergistic pharmacological and non-pharmacological approaches. In line with this, accumulating studies indicate that anesthetic agents could drive both protumor or antitumor signaling pathways during or after cancer surgery. While preclinical investigations focusing on anesthetics’ impact on the behavior of cancer cells are quite convincing, limited clinical trials studying the consequences on survival and recurrences remain inconclusive. Herein, we highlight the main factors occurring during the perioperative period of cancer surgery and their potential impact on immunomodulation and cancer progression. We also discuss patient management prior to and during surgery, taking into consideration the latest advances in the literature.

Background: General anaesthesia is standard of care for patients undergoing robot assisted laparoscopic prostatectomy (RALP). However, postoperative pain and bladder discomfort remains an issue, and optimising pain management could improve recovery and promote earlier home discharge. The main objective of this trial was to evaluate if patients receiving spinal anaesthesia are more frequently home ready at 8 pm on the same day compared with multimodal pain management following RALP under general anaesthesia.Methods: This pragmatic, randomised controlled, multicentre trial was performed between January 2019 to December 2021. Patients undergoing RALP under general anaesthesia were randomised to either multimodal analgesia using parecoxib and morphine intra‐operatively (Group GM) or spinal anaesthesia with bupivacaine and sufentanil (Group GS). The primary aim, home readiness, was assessed using a post‐anaesthesia discharge scoring system.Results: Of 202 patients analysed, 27% patients reached home readiness criteria after 12 h, 46% after 24 h and 79% after 48 h, without differences between the groups. Urge to pass urine was greater in group GM than in group GS (p ⟨0.001) and lasted for a median of two hours in both groups. More patients expressed satisfaction with postoperative care in group GS (p ⟨0.001). No other significant differences were found between the groups.Discussion: We found no difference in time to home readiness between the groups. Approximately one‐fourth of the patients achieved home readiness the same day after surgery without difference between the groups. Fewer patients had urge, and patient satisfaction was greater in group GS.

Ovarian cancer ranks as a gynecological malignancy with poor prognosis, specifically if detected late. Primary treatment includes cytoreductive surgery and adjuvant chemotherapy with curative intent. Local anesthetics (LA) administered in the perioperative period may potentially impact patient outcome by several mechanisms. The beneficial impact of LA has been attributed, among other factors, to the drug's inhibitory effect on cancer cells. The primary aim of the study was to evaluate the effect of clinically relevant concentrations of ropivacaine and lidocaine on ovarian cancer cell lines. Three ovarian cancer cell lines (SKOV-3, SW-626 and CA-OV-3) were treated with 1, 10, 100, or 1000 μM of the two LAs. Cell function and morphology were assessed in the following ways: cell counting, phase-contrast and holographic microscopy, a conventional MTT assay for dose response testing, wound healing assay for migration, and cancer stem cell (CSC) identification by aldehyde dehydrogenase, RESULTS: Both ropivacaine and lidocaine significantly reduced cell number, altered morphology, suppressed migration, and decreased the population of CSCs in a concentration-dependent manner. LAs exert a direct inhibitory effect on ovarian cancer cell lines in vitro, suggesting their potential benefits in perioperative management for patients undergoing surgery. Clinical studies using LA during ovarian cancer surgery are needed.