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• physiology and non-communicable disease
• cancer/oncology

• Anaesthetics
• Sports and Exercise Medicine

• Clinical Trials
• Oncology
• Other

Anaesthesia

Having instigated the field of investigation into the effect of anaesthesia and perioperative interventions during cancer surgery on recurrence or metastasis, we are world leader in ongoing clinical trials and translational experimental studies. The EU has funded COST Action 15204 (www.cost.eu/COST_Actions/ca/CA15204), a collaborative of European researchers in this area. This includes evaluation of the effect of local anaesthetics and other perioperative drugs and techniques on perioperative models of cancer metastasis.
1. Opioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery? Curr Opin Anaesthesiol. 2016 Aug;29(4):468-74. doi: 10.1097/ACO.0000000000000360.
2. Consensus statement from the BJA Workshop on Cancer and Anaesthesia. Br J Anaesth. 2015 Jan;114(1):2-3. doi: 10.1093/bja/aeu262.
3. Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery. Br J Anaesth. 2014 Jul;113 Suppl 1:i56-62. doi: 10.1093/bja/aeu200

Circulating tumour cells (CTCs) have attracted recent interest in cancer research as a potential biomarker and a means of studying the process of metastasis. CTC enumeration has been used to guide prognosis in patients with metastatic disease, and to act as a surrogate marker for disease response during therapy. Molecular and genetic characterization of CTCs may act as a "liquid biopsy" and HER2, KRAS and EGFR status in breast, colon and lung cancer CTCs respectively have been defined.

We have hypothesized that anaesthetic, analgesic and perioperative interventions in cancer surgery may effect whether CTCs die or survive and thrive to develop into metastasis subsequently.

We propose to sample whole blood, before and after surgery, from breast, lung and colon cancer patients who are being randomized into long-term follow-up trials of the effect of different anaesthetic techniques on cancer outcomes, to evaluate their influence on CTC enumeration, biological activity and cancer related molecular characterization. We will also investigate the influence of anaesthetic technique on immunological responses to CTCs. We will build on existing collaborations with clinical oncology and surgery colleagues, in addition to cancer molecular biologists and immunologists, to optimize the multidisciplinary synergies necessary to deliver these research answers and postgraduate training opportunities.