Effect of Anesthesia on Lung Cancer Behavior : from Bench to Bedside

Among all cancers, Lung cancer has the highest incidence and surgical resection remains the mainstay modality. However, in addition to surgery itself, several perioperative managements are also known to associated with immunosuppression and resulting tumor spread. Current literatures are mostly limited to retrospective analysis or animal studies. Tumor metastasis are the main causes after tumor resection and are closely related to the immune status. Inhalation anesthetics are known to have immunosuppressive effects, but both local anesthetics and propofol commonly accompanying peripheral nerve blocks have opposite effect against tumor behavior in comparison to inhalation anesthetics. Among immune system, natural killer cells are the key gatekeeper to control tumor metastasis. Furthermore, liquid biopsy can provide fruitful information regarding tumor behavior, including circulating tumor cells and exosomes. Our group proposed a safer and easier alternative to paravertebral block for one-port video-assisted thoracic surgery, namely VATS block. In the project, in addition to investigating the effects of anesthetics on tumor behavior by cell and animal models, we aim to examine clinical applicability of VATS block for lung surgery and compare it with anesthetics-based general anesthesia in regards to natural killer cells infiltration and liquid biopsy with inhalation by exposing two possibly tumor-suppressing agents, local anesthetic and propofol during VATS block.