Research in Perioperative Care of the Cancer Patient: Opportunities and Challenges.

The theory that the perioperative period is critical for oncological outcomes has been a matter of extensive preclinical and clinical research. Basic science research strongly supports the notion that surgical stress, anesthetics, and analgesics influence the mechanisms of cancer progression. Hence, it is hypothesized that perioperative interventions that impact mechanisms or predictors of tumor progression can also affect patients' survival. As a result of that hypothesis, clinical researchers have conducted many retrospective studies. However, much fewer randomized controlled trials have been performed to investigate whether surgery itself (minimally invasive versus open procedures), anesthetics (volatile anesthetics versus propofol-based anesthesia), analgesics (opioids versus opioid-free anesthesia), and blood transfusions (transfusions versus no transfusions) modify the survival of patients with cancer. Unfortunately, randomized controlled trials have failed to translate the preclinical results into clinical outcomes. In this review, I will highlight the challenges of translating basic science to clinical outcomes. We will also point out opportunities for future research.