Effects of TIVA Versus Inhalational Anaesthesia on Circulating Tumour Cells in Hepatocellular Carcinoma Patients
Status:
Recruiting
Trial end date:
2022-12-31
Target enrollment:
Participant gender:
Summary
More than 80% of patients with cancer will be exposed to anaesthesia at some point in their
treatment. There is increasing evidence that perioperative events, including the type of
anaesthesia drugs utilised, have an impact on cancer recurrence and metastases.
Although potentially and theoretically curative, surgical resection, manipulation and trauma
may disseminate tumour cells and reduce immunity. There have been a number of suggestions as
to why cancer may be, paradoxically, worsened by surgery and what methods may be used to
mitigate this. One of these is propofol based total intravenous anaesthesia (TIVA), whereby
the traditional inhalational anaesthetic drugs are avoided. Commonly used inhalational drugs,
such as sevoflurane and desflurane, are pro-inflammatory.
Propofol, however, has anti-inflammatory and anti-oxidative properties, induces apoptosis and
has specific inhibitory effects on tumour cell growth in vitro. Laboratory investigations,
animal models, retrospective clinical studies and initial clinical research are producing
evidence that inhalational anaesthesia facilitates tumour recurrence and metastasis, whilst
TIVA can prolong survival.
This randomised, controlled trial will look at the effects on DNA damage and biomarkers of
immunity and inflammation of inhalational anaesthesia versus TIVA in patients undergoing
surgery for hepatocellular carcinoma, a common tumour in the Southern Chinese population, for
whom surgery is potentially-curative. It will focus on subjects undergoing open hepatectomy
and investigate changes in biomarkers of inflammation, immunity and gene expression from the
patients' blood samples taken before, during and after surgery.
Patients will also be followed-up for cancer recurrence, morbidity and five-year mortality.
Results could represent a breakthrough in knowledge of how anaesthetic agents impact the
results of cancer surgery, and have important implications for a more disease- sensitive
approach to improving management and outcomes in these patients.