Speakers
Prof. Bernhard RIEDEL
Director of the Department of Anaesthesia
Perioperative and Pain Medicine Peter MacCallum Cancer Centre
Melbourne, Australia
Bernhard is an academic anaesthesiologist, the Director, Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, and Professorial appointment at the University of Melbourne in Australia. Prior appointments include Professor and Deputy Chair, Anesthesiology and Intensive Care, M.D. Anderson Cancer Centre (USA); Professor of Cardiothoracic Anesthesiology, Vanderbilt University (USA); Consultant Anaesthetist, Royal Brompton & Harefield NHS Trust (UK). To address the ‘hidden pandemic’ of morbidity and death after surgery, his research is focused on improving outcomes after major surgery through enhanced preoperative risk stratification and optimization of modifiable risk. Specific to cancer surgery, he investigates the interaction of perioperative adrenergic-inflammatory response and anaesthetic technique on tumour-progression/recurrence. His research program has resulted in research grants (>$14M), >200 peer-reviewed scientific publications (including: Lancet, New England Journal Medicine, JAMA, Cancer Research, Nature Reviews, British Journal Anaesthesia), and has been cited >3,000 times. He has edited three books (including ‘Acute Care of the Cancer Patient’). Bernhard has delivered >200 lectures at national/international conferences and effective mentorship has resulted in numerous awards to team members for clinical service, quality improvement, and research.
Surgery is essential for global cancer care and is required by more than two-thirds of individuals diagnosed with cancer. Unfortunately, cancer recurrence and cancer-related deaths remain high despite advances in cancer therapy, with up to 80% of deaths attributed to metastatic disease. The surgical stress response (biologic perturbation characterised by adrenergic-inflammatory activation and consequent immune suppression) that occurs during the perioperative period (and continues for days after surgery) is now acknowledged as having a disproportionate impact on long-term cancer outcomes relative to its short duration and may promote metastatic disease. Preclinical experiments corroborate this 'inconvenient truth' of surgical stress impacting cancer outcomes, highlighting the biological plausibility of the association between surgical stress and cancer recurrence. Clinical observation of improved cancer survival associated with specific anaesthetic strategies (TIVA, lidocaine, NSAIDs, beta-blockers, neuraxial blocks) is promising. This effect is likely mediated through modulation of the surgical stress response, immune system and cancer signalling pathways (apoptosis, angiogenesis, proliferation, etc.). However, we urgently require robust prospective clinical evidence to define the best perioperative care during cancer surgery to inform clinical practice. Such studies are underway. Notably, a core component of perioperative cancer care should remain focused on reducing clinical variability (e.g. ERAS) and addressing patient modifiable risk (prehabilitation) to reduce postoperative complications and thereby ensure that patients stay the course of their cancer journey, including achieving adjuvant (postoperative) chemoradiotherapy, to attain optimal cancer outcomes.
