GA for pancreatic cancer surgery tied to perioperative tryptophan depletion and increased taurine synthesis

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.

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.

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.