Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation

Abstract

Purpose Retrospective studies have associated perioperative regional anesthesia/analgesia during mastectomy for breast cancer with a decreased incidence of cancer recurrence. However, to date, no prospective data from a randomized, controlled trial has been reported. In a previous study we found that extending a single-injection paravertebral block with a multiple-day perineural local anesthetic infusion improves analgesia. This follow-up study investigates the rates of cancer recurrence for the single-injection and multiple-day infusion treatments. Methods Patients undergoing unilateral (n=24) or bilateral mastectomy (n=36) were included in the study. All had been diagnosed with breast cancer or tumor in situ, except for six patients who were receiving prophylactic bilateral mastectomy and were excluded from analyses. Patients received unilateral or bilateral single-injection thoracic paravertebral block(s) corresponding with their surgical site(s) with ropivacaine and perineural catheter(s). Subsequently, patients were randomized to receive either ropivacaine 0.4% (n=30) or normal saline (n=30) via their catheter(s) until catheter removal on postoperative day 3. Cancer recurrence from the date of surgery until at least 2 years post-surgery was investigated via chart review. Results Five of the 54 (9.2%) patients experienced a cancer recurrence following mastectomy: 3 of 26 (11.5%) of the patients with perineural ropivacaine and 2 of 28 (7.1%) of the patients with perineural saline. Conclusions This pilot study found no evidence that extending a single-injection paravertebral block with a multi-day perineural local anesthetic infusion decreases the risk post-mastectomy cancer recurrence. However, due to the small sample size of this investigation, further research is needed to draw definitive conclusions.

Impact of Regional Anesthesia on Recurrence, Metastasis, and Immune Response in Breast Cancer Surgery

“…Thus, interpretation of its results should be taken with extreme caution. 18 In 2006, Exadaktylos et al 10 showed that women receiving a combination of PVB and propofol GA had slower times to recurrence than did those having GA with sevoflurane and opioids. In that study, the rate of recurrence was 6% in patients in the PVB/propofol group versus 24% in those in the sevoflurane/ opioid anesthesia group.…”

“…The only published RCT showed no difference in the rate of recurrence between patients who had PVB versus placebo. 18 Among the retrospective studies, 1 study showed a beneficial effect of PVB, 1 study showed a negative impact on PVB, and the remainder found no association between the use of PVB and a reduced rate of cancer recurrence or longer cancer-related survival. 10,14,15,17 A meta-analysis was not conducted because of (a) low-quality studies, (b) different staging and molecular tumor markers in the patients included in each study, (c) different solutions of local anesthetics used for PVB, and (d) differences in outcome definitions.…”

Ropivacaine promotes apoptosis of hepatocellular carcinoma cells through damaging mitochondria and activating caspase-3 activity

“…Local anaesthetic agents have broad therapeutic functions that go beyond the known analgesia and antiarrhythmic [1]. They are applied in a wide range of clinical situations to prevent or reduce acute pain, chronic pain and cancer pain [2, 3].…”

Anestesia no paciente oncológico

“…Entretanto, uma metanálise realizada com 28 estudos e mais de 67.000 pacientes não encontrou relação entre a anestesia regional com redução de recidiva do tumor ou sobrevida dos pacientes 41 . Um estudo piloto prospectivo, randomizado e triplo cego avaliou pacientes submetidas à mastectomia comparando anestesia geral + paravertebral versus anestesia geral e, até o momento, não houve diferença de recorrência tumoral entre os grupos 42 .…”