Table 2.

Perioperative factors affecting cancer progression.

I. Surgical factors

1. Cancer cells enter the cardiovascular system during surgical procedures, including tumour resection, and subsequently spread across the body [36].

2. Surgical procedures activate and intensify the proliferation of cancer cells, stimulate their mobility and invasiveness, and increase their capacity for adhesion [37, 38].

3. Surgical factors inhibit the apoptosis of cancer cells [37].

4. Angiogenesis and the network of newly created blood vessels constitute a kind of “pathway” for the transfer of cancer cells to the host cardiovascular and further to metastatic lesion sites [39].

5. The selection of the surgical technique: less invasive techniques, including laparoscopic ones, have a less intense immunosuppressive effect compared with open techniques [40].

II. The transfusion of blood and blood products, especially those kept in long-term storage [41].

III. Hypothermia leads to glucocorticosteroid burst and impaired immune cellular and humoral response [42].

IV. Stress and pain, often experienced by patients during the perioperative period, cause stress hormone bursts and impair cellular immunity, including the activity of NK cells [43, 44].

VI. Anaesthetic management: type of anaesthesia used (general and regional), choice of drugs, especially opioids [50–55].