The Impact of Perioperative Events on Cancer Recurrence and Metastasis in Patients after Radical Gastrectomy: A Review

SIMPLE SUMMARY: Gastric cancer (GC) patients who are candidates for radical gastrectomy will experience various perioperative events, which have been shown to promote recurrence and decrease the long-term survival of GC patients. Therefore, although the perioperative period is relatively short, it is critical in determining the local recurrence and distant metastasis risk after radical gastrectomy. Herein, we will summarize the perioperative events and their effects on the long-term survival of patients with GC. Then, we discuss the possible mechanisms underlying perioperative vulnerability to cancer recurrence, directing the investigation of perioperative strategies to improve the survival of patients following gastrectomy. ABSTRACT: Radical gastrectomy is a mainstay therapy for patients with locally resectable gastric cancer (GC). GC patients who are candidates for radical gastrectomy will experience at least part of the following perioperative events: surgery, anesthesia, pain, intraoperative blood loss, allogeneic blood transfusion, postoperative complications, and their related anxiety, depression and stress response. Considerable clinical studies have shown that these perioperative events can promote recurrence and decrease the long-term survival of GC patients. The mechanisms include activation of neural signaling and the inflammatory response, suppression of antimetastatic immunity, increased release of cancer cells into circulation, and delayed adjuvant therapy, which are involved in every step of the invasion-metastasis cascade. Having appreciated these perioperative events and their influence on the risk of GC recurrence, we can now use this knowledge to find strategies that might substantially prevent the deleterious recurrence-promoting effects of perioperative events, potentially increasing cancer-free survival in GC patients.