Understanding clinical strategies that may impact tumour growth and metastatic spread at the time of cancer surgery.

The role of the perioperative period during cancer surgery and its impact on patients' long-term cancer outcomes are of increasing interest. Anticipation and prevention of perioperative immunosuppression and targeted therapeutic interventions that translate to reduced cancer recurrence are increasingly being explored. These interventions may focus on reducing the systemic inflammatory response, the regional lymphatic flow induced by surgical inflammation and exposure to perioperative immunosuppressive agents. The challenge has been to provide evidence-based links between these hypothesised cancer 'reducing' strategies, our knowledge of cancer biology and tangible long-term clinical outcomes of improved recurrence-free and overall survival. Anaesthesiologists caring for patients with cancer may preferentially employ regional anaesthesia techniques and anti-inflammatory agents to minimise perioperative immunosuppression and preserve perioperative homeostasis. However, prospective trials powered for long-term cancer outcomes are necessary to provide an evidence base before these strategies are to be recommended for routine clinical practice. Crown