Epidural anesthesia and cancer recurrence rates after radical prostatectomy

Abstract

Purpose To determine the effect of adjunctive epidural local anesthetic and opioid infusion on disease recurrence following radical prostatectomy for adenocarcinoma under general anesthesia. Methods This article describes a secondary analysis of subjects undergoing radical prostatectomy who had participated previously in a randomized controlled trial evaluating pain control, blood loss, and the need for perioperative allogeneic blood transfusion. The patients were randomly allocated to receive either general anesthesia alone (control group; n = 50) or combined general/ epidural anesthesia (study group; n = 49). A long-term follow-up chart review was undertaken to determine clinically evident or biochemical (Prostate Specific Antigen [0.2 ng Á mL -1 ) recurrence of prostate cancer. Comparison by group was undertaken using survival analysis.Results Median disease-free survival for the study as a whole was 1644 days, and the longest recorded survival was 3403 days. Biochemical recurrence of prostate cancer was observed in 11/49 study subjects and 17/50 control subjects. There was one death from prostate cancer in each group and a total of five deaths in the study group and six deaths in the control group. The hazard ratio for recurrence in the study group compared with the control group was 1.33 (95% confidence intervals 0.64-2.77; P = 0.44 by log-rank test). Conclusion No difference was observed between the epidural and control groups in disease-free survival at a median follow-up time of 4.5 years. There is a need for large randomized controlled trials to determine the ability of epidural analgesia to alter disease recurrence rates following radical prostatectomy. RésuméObjectif De´terminer l'effet d'une the´rapie adjuvante d'anesthe´sique local pe´ridural et perfusion d'opioı¨des sur la re´currence de la maladie apre`s une prostatectomie radicale pour ade´nocarcinome sous anesthe´sie ge´ne´rale. Méthode Cet article de´crit une analyse secondaire de patients ayant subi une prostatectomie radicale, lesquels avaient pre´ce´demment participe´a`une e´tude randomise´e contrôle´e e´valuant le contrôle de la douleur, les pertes sanguines et le besoin de transfusions sanguines alloge`nes en pe´riode pe´riope´ratoire. Les patients ont e´te´randomise´s a`recevoir soit une anesthe´sie ge´ne´rale seule (groupe te´moin; n = 50) ou une combinaison d'anesthe´sie ge´ne´rale et pe´ridurale (groupe a`l'e´tude; n = 49). Une re´vision des dossiers de suivi a`long terme a e´te´entreprise afin de

The Effects of Epidural Anaesthesia and Analgesia on Natural Killer Cell Cytotoxicity and Cytokine Response in Patients with Epithelial Ovarian Cancer Undergoing Radical Resection

“…This may help to explain why epidural anaesthesia and analgesia might protect the body's immune function, and have been associated with decreased recurrence rates and prolonged survival in patients with malignancies. 37 In conclusion, the present prospective randomized trial in 61 women undergoing radical resection for EOC demonstrated significant differences in NKCC and cytokine responses between patients receiving combined general/epidural anaesthesia and general anaesthesia alone. Combined general/epidural anaesthesia appeared to promote antitumourigenic NKCC and cytokine responses.…”

Is regular systemic opioid analgesia associated with shorter survival in adult patients with cancer? A systematic literature review

“…Several long term retrospective studies have shown a benefit of the opioid-sparing effect of regional or spinal analgesia, alongside general anaesthesia, on cancer recurrence or survival in the resection of breast, prostate and colon tumours [36][37][38]. However other retrospective studies have not shown these benefits in prostate, colorectal, and cervical cancers even though there was a reduced need for postoperative opioids [39][40][41]. In surgery for early lung cancer, intraoperative opioids were associated with shorter survival, which was not the case in later stage disease [42].…”

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

“…16 Nevertheless, there is substantial challenge to such translational work, and clinical studies have not found a consistent association between opioid-sparing and oncological outcomes. [17][18][19][20][21][22][23][24][25][26][27] One challenge with contemporary anesthetic practices is the impracticality of accomplishing acceptable analgesia without some perioperative opioids. This reality impedes definitive prospective research on whether complete avoidance of perioperative opioids modifies oncological outcomes.…”