Effect of perioperative regional anesthesia on cancer recurrence: A meta-analysis of randomized controlled trials

Lee, Zong Xuan; Ng, Ka Ting; Ang, Eshen; Wang, Chew Yin; Shariffuddin, Ina Ismiarti

doi:10.1016/j.ijsu.2020.08.034

Cited by 13 publications

(14 citation statements)

References 45 publications

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“…According to a prospective clinical study, epidural anesthesia during surgery does not improve their disease-free survival [46]. Similarly, a meta-analysis that included six prospective clinical trials came to the conclusion that the combination of RA and GA did not decrease cancer recurrence after tumor resection [47].…”

Section: Discussionmentioning

confidence: 99%

Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Wang

Song

Qin

et al. 2023

Preprint

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Background Regional anesthesia appears to reduce cancer recurrence, but the optimal anesthesia modality for non-muscle invasive bladder cancer (NMIBC) were still under debate. Therefore, we sought to assess the effect of regional and GA only upon the recurrence and long-term prognosis of NMIBC through this meta-analysis. Methods We performed an extensive literature search of PubMed, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (up to October 30, 2022) to identify eligible articles on the possible impact of different anesthetic modalities for the recurrence rate of NMIBC. Results Eight studies comprising 3764 participants, including 2117 subjects with RA and 1647 with GA, were finally enrolled. Cancer recurrence rate was significantly lower in subjects with RA than those with GA. (RR 0.84, 95%CI 0.72–0.98, P = 0.031). Significant differences were not detected between GA and RA in the time of recurrence (SMD 2.07, 95% CI -0.49-4.64, P = 0.113) and cancer progression (RR 1.14, 95%CI 0.71–1.84, P = 0.589). Results from subgroup analysis demonstrated that spinal anesthesia could significantly decrease the incidence of cancer recurrence in comparison with general anesthesia (RR 0.80, 95%CI 0.72–0.88, P < 0.001) and subjcets with high-risk NMIBC who received RA tended to have less recurrence (HR 0.55, 95%CI 0.38–0.78, P = 0.001). Conclusions RA, especially spinal anesthesia, is effective in reducing the recurrence rate after transurethral resection of NMIBC. High-risk NMIBC patients were significantly less likely to experience cancer recurrence when RA was adopted during surgery. Trial registration INPLASY registration INPLASY2022110097

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Section: Discussionmentioning

confidence: 99%

Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Wang

Song

Qin

et al. 2023

Preprint

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“…Therefore, a Cochrane analysis from 2014 has rated the evidence to support a benefit of RA regarding tumor recurrence as being inadequate due to the lack of prospective, sufficiently powered clinical trials [ 34 ]. Several more recent meta-analyses also failed to provide sufficient evidence to prove the hypothesis of a possible anti-metastatic effect of the perioperative use of RA, although the quality of evidence might still be considered to be low [ 35 , 36 , 37 ]. However, several authors have provided experimental in vitro and in vivo data to support the hypothesis that LA might bear the potential to inhibit crucial signaling events in malignant cells, ultimately inhibiting the cells’ ability to metastasize [ 13 , 15 , 38 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Intraoperative Blood Transfusion, Regional Anesthesia and Outcome after Pediatric Tumor Surgery for Nephroblastoma

Müller

Both

Sponholz

et al. 2022

Cancers

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Background: Recent data suggest that anesthesiologic interventions—e.g., the choice of the anesthetic regimen or the administration of blood products—might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients. Methods: A retrospective multicenter study assessing data from pediatric patients (0–18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes. Results: In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36–42.2, p = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42–68.4, p = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio. Conclusions: The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.

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“…This study by Sessler et al was also included into a recent meta-analysis, comprising six randomized control trials, and the authors report no difference in rates of cancer recurrence, overall survival with the addition of regional anesthesia to general anesthesia for cancer surgery [81 ▪▪ ]. The authors did note, however, that a low level of evidence and substantial heterogeneity exists and that their findings should be interpreted with caution.…”

Section: Regional Anesthesia and Cancer Outcomesmentioning

confidence: 99%

Anesthetic technique and cancer surgery outcomes

Dubowitz

Hiller

Riedel

2021

Current Opinion in Anaesthesiology

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Purpose of reviewSurgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes. Recent findingsTo date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research.

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Effect of perioperative regional anesthesia on cancer recurrence: A meta-analysis of randomized controlled trials

Cited by 13 publications

References 45 publications

Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Association between Intraoperative Blood Transfusion, Regional Anesthesia and Outcome after Pediatric Tumor Surgery for Nephroblastoma

Anesthetic technique and cancer surgery outcomes

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