Opioids and cancer survival: are we looking in the wrong place?
نویسندگان
چکیده
There is a controversial narrative in the anaesthetic literature suggesting that technique (including opioids) may be detrimental to survival after tumour resection. The initial observations were retrospective. Several prospective studies are ongoing; one breast cancer has reported no adverse outcome. evidence for an effect of opioids stems from three pieces information: (1) depress immune system, (2) potentially promote angiogenesis, and (3) support growth. Although (2)/(3) unclear, combinations these effects beneficial tumours metastatic reseeding. Accepted wisdom suggests opioid driven by receptor activation but presence receptors on cells example unlikely. Immune cells, vascular endothelium range express Toll-like 4 (TLR4) (for Gram-negative bacterial wall components), there growing interacting with this alternative receptor; some paradoxical naloxone sensitivity. Is focus wrong target? TLR4 produces activation, stimulates supports survival. We know more suppressive than others (there such comparative information angiogenesis survival); correlate activation. If clusters have profiles vice versa , influence case, then evidence-based advice could given perioperative use oncology–anaesthesia setting.
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ژورنال
عنوان ژورنال: BJA open
سال: 2022
ISSN: ['2772-6096']
DOI: https://doi.org/10.1016/j.bjao.2022.100010