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The Combined Blockade of &bgr;-Adrenoceptor and COX-2 During the Perioperative Period to Improve Long-term Cancer Outcomes

For most patients with cancer, the surgical removal of the primary tumor is a necessary and lifesaving intervention. Yet, accumulating evidence suggests that different aspects of surgery and the accompanying stress response also facilitate cancer progression through various mechanisms. For example, general anesthesia (GA), analgesic and sedative agents, blood transfusions, and hypothermia are all associated with increased recurrence and metastatic disease. Specifically, the excision of the tumor induces a cascade of events that facilitate cancer progression. Although surgeons commonly achieve negative margins, the unavoidable tissue damage and mechanical manipulation of the tumor and its blood vessels causes shedding of tumor cells into the lymphatic and blood circulations. As cancer cells are disseminated throughout the body, the patient’s response to the incision also causes an increase in local and systemic levels of growth factors, which may promote local recurrence and metastatic growth. The removal of the