Intraoperative Neuraxial Anesthesia But Not Postoperative Neuraxial Analgesia Is Associated With Increased Relapse-Free Survival in Ovarian Cancer Patients After Primary Cytoreductive Surgery

Oliveira, Gildàsio S. De; Ahmad, Shireen; Schink, Julian C.; Singh, Diljeet K.; Fitzgerald, Paul C.; McCarthy, Robert J.

doi:10.1097/aap.0b013e318217aada

Cited by 141 publications

(78 citation statements)

References 19 publications

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“…9,10 These findings may therefore imply an association between anesthetic management and long-term outcome. Although NA may reduce the number of postoperative complications and improve short-term mortality in patients undergoing TJR, it remains unknown whether it may also influence long-term survival in these patients.…”

Section: Résumémentioning

confidence: 93%

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Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan

Chen

Hung

Tan

et al. 2015

Can J Anesth/J Can Anesth

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Introduction This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. Methods From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-scorematched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA. Results Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P \ 0.001) and shorter median days vs 8 [6-10] days, respectively; P = 0.024). Conclusions Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.

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Section: Résumémentioning

confidence: 93%

“…Nous avons créé deux sous-groupes appariés par score de propension, chacun incluant un nombre égal de patients ayant subi une AT sous AG ou AN. (8 [7-10] jours contre 8 [6][7][8][9][10] jours; P = 0,024). Conclusions Nos résultats sont en faveur de l'utilisation de l'AN pour les AT de première intention.…”

Section: Résuméunclassified

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan

Chen

Hung

Tan

et al. 2015

Can J Anesth/J Can Anesth

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“…Six retrospective studies have addressed the question of whether regional analgesia, specifically neuraxial analgesia, has a significant impact on recurrence after genitourologic cancers [2,3,11,15,25,37] (Table 1). The results of three studies conducted in patients with prostate cancer are inconsistent [2,15,37].…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 99%

“…The results of the three retrospective studies in patients with ovarian cancer likewise differed importantly from one another [3,11,25]. Briefly, de Oliveira et al [11] demonstrated that only the use of combined intraoperative epidural-general analgesia followed by postoperative epidural analgesia (n = 26) was associated with better recurrence-free survival compared to either general anesthesia/intravenous analgesia (n = 127) or general anesthesia/postoperative epidural analgesia (n = 29).…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 99%

“…Briefly, de Oliveira et al [11] demonstrated that only the use of combined intraoperative epidural-general analgesia followed by postoperative epidural analgesia (n = 26) was associated with better recurrence-free survival compared to either general anesthesia/intravenous analgesia (n = 127) or general anesthesia/postoperative epidural analgesia (n = 29). This is in agreement with Lin et al [25] who showed in 143 patients that surgery under epidural anesthesia/analgesia was more beneficial to patient survival than surgery under general anesthesia and postoperative intravenous opioid analgesia.…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 99%

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Can Regional Anesthesia and Analgesia Prolong Cancer Survival After Orthopaedic Oncologic Surgery?

Cata

Hernandez

Lewis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence. Questions/purposes We performed a systematic review of the literature on the use of regional anesthesia and postoperative analgesia to improve cancer-related survival after oncologic surgery. Our primary topic of interest is survival after orthopaedic oncologic surgery, but because that literature is limited, we also have systematically reviewed the question of survival after breast, gastrointestinal, and genitourologic cancers.

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Anaesthetic techniques for risk of malignant tumour recurrence

Çakmakkaya

Kolodzie

Apfel

et al. 2014

Cochrane Database of Systematic Reviews

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Intraoperative Neuraxial Anesthesia But Not Postoperative Neuraxial Analgesia Is Associated With Increased Relapse-Free Survival in Ovarian Cancer Patients After Primary Cytoreductive Surgery

Abstract: Intraoperative use of epidural anesthesia was associated with an increased time to tumor recurrence after surgery in ovarian cancer patients. This may be a result of preservation of the immune system function.

Cited by 141 publications

References 19 publications

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan

Can Regional Anesthesia and Analgesia Prolong Cancer Survival After Orthopaedic Oncologic Surgery?

Anaesthetic techniques for risk of malignant tumour recurrence

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