Neoadjuvant chemotherapy and perioperative cardiotoxicity

Malignant tumors constitute a major threaten to human health and are among the most serious public health challenges both in China and globally. Many patients with malignancy require neoadjuvant chemotherapy prior to surgery. Neoadjuvant chemotherapy, which involves administering systemic chemotherapy before local treatment (such as surgery or radiotherapy) for malignant tumors, offers several benefits. These include tumor shrinkage, the reduction of the pathological stage of primary lesions and metastatic lymph nodes, and the early elimination of possible smile metastases. This pre-operative therapy is advantageous as it paves the way for more successful surgical treatment. Nonetheless, research indicates that neoadjuvant chemotherapy may lead to cardiotoxicity, resulting in myocardial ischemia, arrhythmia, arterial hypertension, and even heart failure. Therefore, the use of precision anesthesia, combined with cardioprotective strategies during surgery, is essential. By employing these measures, the surgical procedure can be performed more effectively, ultimately contributing to improved long-term survival outcomes for patients. The focus of this review is to discuss the typical treatment protocols for neoadjuvant chemotherapy, the underlying mechanisms of cardiotoxicity, and the importance of monitoring, assessing, and safeguarding perioperative cardiac function in surgical patients who have undergone neoadjuvant chemotherapy. By examining these aspects, this review aims to offer insights that can guide anesthesia management during the perioperative period for cancer surgery patients.