Oncotarget: General anesthesia for pancreatic cancer surgery

Oncotarget published "Perioperative changes in the plasma metabolome of patients receiving general anesthesia for pancreatic cancer surgery" which reported that little is known about the impact of anesthesia on the plasma metabolome, although many metabolites have been shown to modulate the function of various immune cells, making it particularly interesting in the context of oncological surgery.

In this study longitudinal dynamics in the plasma metabolome during general anesthesia in patients undergoing pancreatic surgery were analyzed.

Prospective, observational study with 10 patients diagnosed with pancreatic malignancy and subjected to elective resection surgery under general anesthesia.

Plasma metabolites were quantified at eight consecutive perioperative timepoints using mass spectrometry-based targeted metabolomics.

The major finding of this Oncotarget study was perioperative tryptophan depletion and increased taurine synthesis.

The major finding of this Oncotarget study was perioperative tryptophan depletion and increased taurine synthesis.

Dr. Johanna Mock-Ohnesorge from The Heidelberg University Hospital said, "Although general anesthesia using intravenous and volatile anesthetics is well and safely established for extended abdominal surgery, little is known about the effects of anesthesia on perioperative metabolism."

While in the past, anesthetic procedures were considered sole prerequisites of surgery, modern anesthesia evolved to become more individualized in an effort to address a patient's individual needs regarding the metabolic, physiological and immunological integrity in sight of long-term clinical outcome.

Since immune cells as natural killer cells or CD8 T-cells have the capability to identify and eliminate these malignant cells, the perioperative immune status plays an essential role for anti-tumor activities.

A plethora of factors contribute to a complex modulation of immune function during surgery, e.g., the release of damage-associated molecular patterns from injured tissue and the organism's release of metabolites in response to anesthesia and surgical stress.

The objective of this prospective, exploratory study is to gain information on longitudinal perioperative alterations in the plasma metabolome during general anesthesia in patients diagnosed with pancreatic malignancies leading to a better understanding for personalized perioperative management.

Figure 5: Late onset metabolomic changes. (A) Carnitine decreased significantly from T1 to T8 (p = 9.30E-04, adjusted for multiple testing) and propionyl carnitine decreased to a slighter extent (p = 1.64E-04). (B) Highly dynamic alterations in lactate concentrations. Lactate concentrations decreased within the anesthetic period and increased to an even greater extent in the consecutive joint period (p = 2.65E-03). (C) Hydroxyproline (marker for collagen turnover) significantly decreased after beginning of surgical procedures (p = 3.05E-03). (D) Triglyceride concentrations decreased in perioperative period. Triacylglyceride 18:1_34:1 as the most abundant one is presented exemplarily. The ratio of [triacylglycerides]/|fatty acids] serves as an indicator for synthesis of triacylglycerides and decreased, symbolizing a degradation of triacylglycerides (p = 8.21E-10). Sum of fatty acids in plasma increased, although this was only significant for monounsaturated fatty acids (p = 0.03).

The Mock-Ohnesorge Research Team concluded in their Oncotarget Research Output that metabolomics represent a phenotype of all genetic, transcriptomic and posttranslational modifications.

Perioperative metabolomic analysis enables to get a more accurate insight on perioperative processes.

This will answer individual needs enabling personalized anesthetic management.

In the field of surgical oncology, it might be even possible to identify therapeutic windows with best conditions for perioperative immunotherapy or chemotherapy.

Further controlled studies are desperately needed to compare the impact of different anesthetic procedures on the plasma metabolome to identify beneficial or detrimental influences on long-term clinical outcome.

DOI - https://doi.org/10.18632/oncotarget.27956

Full text - https://www.oncotarget.com/article/27956/text/

Correspondence to - Johanna Mock-Ohnesorge - johanna.ohnesorge@med.uni-heidelberg.de

Keywords - metabolomics, anesthesia, plasma, tumor, longitudinal

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