Anesthesia in Combination with Propofol Increases Disease-Free Survival in Bladder Cancer Patients Who Undergo Radical Tumor Cystectomy as Compared to Inhalational Anesthetics and Opiate-Based Analgesia

Abstract

<b><i>Background:</i></b>The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival. <b><i>Methods:</i></b>This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated. <b><i>Results:</i></b>The median disease-free survival of the patients who received combined anesthesia was 585 (240–1,005) days versus 210 (90–645) days in the other group. A significant difference was observed between the two groups (<i>p</i> = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315–1,545] disease-free days) and those who received sevoflurane and opioids (150 [90–450] disease-free days) (<i>p</i> = 0.02). <b><i>Conclusions:</i></b>Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.

Effects of propofol on the development of cancer in humans

“…Unfortunately, the surgery process causes a large number of tumour cells to be released, reducing the activity of T, B and NK lymphocytes in the postoperative period, which possibly leads to tumour progression. 2 Anaesthetic agents may play an essential role in tumour relapse and metastasis because they are administered at the moment of greatest risk of transmission: surgical removal of the tumour. 3 Recently, many studies have uncovered that the choice of anaesthetic agent could influence the prognosis of cancer patients undergoing cancer surgery.…”

“…At present, the primary treatment method for most solid cancers is removing the tumour during surgery. Unfortunately, the surgery process causes a large number of tumour cells to be released, reducing the activity of T, B and NK lymphocytes in the postoperative period, which possibly leads to tumour progression 2 . Anaesthetic agents may play an essential role in tumour relapse and metastasis because they are administered at the moment of greatest risk of transmission: surgical removal of the tumour 3 .…”

“…Anaesthetic agents may play an essential role in tumour relapse and metastasis because they are administered at the moment of greatest risk of transmission: surgical removal of the tumour 3 . Recently, many studies have uncovered that the choice of anaesthetic agent could influence the prognosis of cancer patients undergoing cancer surgery 2,4‐9 …”

“…In addition, we also discuss the pivotal role propofol plays in the inhibition of tumour growth and metastasis in vivo and its inhibitory effect on cancer cells when used in combination with chemotherapeutic drugs or molecular compounds. A series of retrospective and prospective clinical trials have reported the relationship between propofol and patient survival outcomes during tumour surgery 2,4‐9,11‐16 …”

More reviews than RCTs

“…But how long should we wait for RCTs, and when is it time for reviews, meta-analyses, and editorials in the development of new knowledge?A recent simple search of the subject on PubMed.gov revealed 13 reviews 1-13 and three meta-analyses, [14][15][16] while the number of retrospective studies was 20 and the number of RCTs was four. [38][39][40][41] Of the latter, the largest contained 126 patients. 39 Such a small number makes it impossible to draw conclusions about a possible difference in survival rate.What have retrospective studies told us so far?…”