Cancer remains a major public health issue and a leading cause of death worldwide. Despite advancements in
chemotherapy,
radiation therapy, and
immunotherapy, surgery is the mainstay of
cancer treatment for solid
tumors. However,
tumor cells are known to disseminate into the vascular and lymphatic systems during surgical manipulation. Additionally, surgery-induced stress responses can produce an immunosuppressive environment that is favorable for
cancer relapse. Up to 90% of
cancer-related deaths are the result of metastatic disease after surgical resection. Emerging evidence shows that the interactions between
tumor cells and the tumor microenvironment (TME) not only play decisive roles in
tumor initiation, progression, and
metastasis but also have profound effects on therapeutic efficacy.
Tumor necrosis factor alpha (TNF-α), a pleiotropic
cytokine contributing to both physiological and
pathological processes, is one of the main
mediators of inflammation-associated
carcinogenesis in the TME. Because TNF-α signaling may modulate the course of
cancer, it can be therapeutically targeted to ameliorate clinical outcomes. As the incidence of
cancer continues to grow, approximately 80% of
cancer patients require
anesthesia during
cancer care for diagnostic, therapeutic, or palliative procedures, and over 60% of
cancer patients receive
anesthesia for primary surgical resection. Numerous studies have demonstrated that perioperative management, including surgical manipulation,
anesthetics/
analgesics, and other supportive care, may alter the TME and
cancer progression by affecting inflammatory or immune responses during
cancer surgery, but the literature about the impact of
anesthesia on the TNF-α production and
cancer progression is limited. Therefore, this review summarizes the current knowledge of the implications of
anesthesia on
cancers from the insights of TNF-α release and provides future
anesthetic strategies for improving oncological survival.