# The Early Effects of Esketamine on the Tumor Metastatic Microenvironment in Postoperative Lung Cancer Patients

## TL;DR

This study examines how esketamine affects the tumor environment in lung cancer patients during surgery, showing it reduces inflammation and changes certain proteins linked to cancer spread.

## Contribution

The study is the first to show that esketamine, used during surgery, alters key proteins in the tumor microenvironment that are associated with cancer metastasis.

## Key findings

- Esketamine reduced levels of VEGF-C and TNF-α, which are linked to cancer spread and inflammation.
- Patients receiving esketamine had lower remifentanil use and longer wake times after surgery.
- Changes in MMP-9 and VEGF-C levels were significant within and between groups.

## Abstract

To investigate the early effect of esketamine on the tumor metastatic microenvironment in patients with lung cancer.

Sixteen adults aged 45–80 years with the American Society of Anesthesiologists (ASA) 1 to 3 were randomly divided into the experimental group (group E) and the control group (group C). Group E received esketamine at 1 mg/kg during anesthesia induction and a continuous infusion of 0.5 mg/kg/h during the surgery. Group C was given the same amount of normal saline infusion. Patient‐controlled intravenous analgesia (PCIA) in group E was administered using dexmedetomidine (0.5 mg/kg) + esketamine (50 mg) + dexamethasone (5 mg). PCIA in group C was the same dose of dexmedetomidine and dexamethasone. Data were recorded at 14 points from admission to the third day after surgery (T0–14). Parameters recorded included hemodynamics, wake time, remifentanil dosage, and so on. At T0, T10, T13, and T14, TNF‐α, IL‐2, IL‐10, MMP‐9, and VEGF‐C were measured.

Compared with T0, the differences of tumor necrosis factor‐α (TNF‐α), interleukin‐2 (IL‐2), matrix metallopeptidase 9 (MMP‐9), and vascular endothelial growth factor‐C (VEGF‐C) in the two groups were statistically significant (p < 0.05). When compared to group C, VEGF‐C in group E was reduced at T10 and T13 (p < 0.05). For both groups, there were intragroup differences in the changes of MMP‐9 and VEGF‐C levels (p < 0.05). Compared to group C, on the postoperative, group E exhibited a lower change rate of TNF‐α and VEGF‐C (p < 0.05).

Perioperative application of esketamine in patients with lung cancer provided significant sedative and analgesic effects and affected cytokines in the tumor microenvironment.

The perioperative administration of esketamine in lung cancer patients prolonged the awakening time, reduced the dosage of remifentanil, and suppressed inflammatory responses.