Recently published studies suggest that the anesthetic technique used during oncologic surgery affects cancer recurrence. To evaluate the effect of anesthetic technique on disease progression and long-term survival, we compared patients receiving general anesthesia plus intraoperative and postoperative thoracic epidural analgesia with patients receiving general anesthesia alone undergoing open retropubic radical prostatectomy with extended pelvic lymph node dissection.
Two sequential series were studied. Patients receiving general anesthesia combined with epidural analgesia (January 1994-June 1997, n=103) were retrospectively compared with a group given general anesthesia combined with ketorolac-morphine analgesia (July 1997-December 2000, n=158). Biochemical recurrence-free survival, clinical progression-free survival, cancer-specific survival, and overall survival were assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional-hazards regression model and an alternative model with inverse probability weights to adjust for propensity score.
Using propensity score adjustment with inverse probability weights, general anesthesia combined with epidural analgesia resulted in improved clinical progression-free survival (hazard ratio, 0.45; 95% confidence interval, 0.27-0.75, P=0.002). No significant differences in the two groups were found for biochemical recurrence-free survival, cancer-specific survival, or overall survival. Higher preoperative serum values for prostate-specific antigen, specimen Gleason score of at least 7, non-organ-confined tumor stage, and positive lymph node status were independent predictors of biochemical recurrence-free survival.
General anesthesia with epidural analgesia was associated with a reduced risk of clinical cancer progression. However, no significant difference was found between general anesthesia plus postoperative ketorolac-morphine analgesia and general anesthesia plus intraoperative and postoperative thoracic epidural analgesia in biochemical recurrence-free survival, cancer-specific survival, or overall survival.
"Experimental studies also suggest that EA may protect intestinal barrier function, improve mucosal capillary perfusion in acute experimental pancreatitis and in sepsis , as well as increase anastomotic mucosal blood flow after oesophageal resection . Furthermore, EA may influence tumour progression after oncological surgery    . Many of these benefits, including EA's analgesic effects, may be relevant to the intensive care unit (ICU) patient. "
"   Opioids Perioperative morphine induces immunosuppression. Hydromorphone, oxycodone, and buprenorphine have lower immunosuppressive activity, and tramadol does not suppress immune functions       Opioids have proangiogenic effect    Methylnaltrexone inhibits angiogenesis and immune response, attenuates tumor growth, and reduces lung metastasis in mice inoculated with cancer cells   The higher MOR expression and opioid dose requirement is associated with shorter survival  Anesthesia Some general anesthetics (ketamine, thiopental, and halothane) suppress NK cell activity and increase metastases  Inhaled anesthetics up-regulate HIF, which can facilitate cancer spread and contribute to cancer recurrence    Propofol is better than inhaled anesthesia in terms of immunity and induces apoptosis in breast cancer cells         General anesthesia combined with regional anesthesia/analgesia improves immune outcome and reduces metastatic burden in animals, risk of metastasis in breast cancer, VEGF and TGF-β expression        Some studies have shown controversial results in terms of survival with epidural anesthesia/analgesia     Prospective ongoing clinical trials are investigating influence of regional anesthesia in some tumor outcomes    6 Anesthesia, cancer progression, cancer outcome, substance P F. Cassinello et al. Dibucaine was the most cytotoxic, followed by tetracaine, bupivacaine, or ethylaminobenzoate, whereas lidocaine, procaine, and mepivacaine were much less cytotoxic. "
"General anesthesia in combination with epidural analgesia seemed to improve disease clinical progression-free survival. However, they did not find significant differences in the two groups in terms of disease biochemical recurrence-free survival, cancer-specific survival, and overall survival . "
[Show abstract][Hide abstract] ABSTRACT: Many of the most common anesthetics are used in surgical oncology, yet effects on cancer cells are still not known. Anesthesia technique could differentially affect cancer recurrence in oncologic patients undergoing surgery, due to immunosuppression, stimulation of angiogenesis, and dissemination of residual cancer cells. Data support the use of intravenous anesthetics, such as propofol anesthesia, thanks to antitumoral protective effects inhibiting cyclooxygenase 2 and prostaglandins E2 in cancer cells, and stimulation of immunity response; a restriction in the use of volatile anesthetics; restriction in the use of opioids as they suppress humoral and cellular immunity, and their chronic use favors angiogenesis and development of metastases; use of locoregional anesthesia compared with general anesthesia, as locoregional appears to reduce cancer recurrence after surgery. However, these findings must be interpreted cautiously as there is no evidence that simple changes in the practice of anesthesia can have a positive impact on postsurgical survival of cancer patients.
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