Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer

Abstract

AIMTo investigate the association between postoperative pain control and oncologic outcomes in resected pancreatic ductal adenocarcinoma (PDAC).METHODSFrom January 2009 to December 2014, 221 patients were diagnosed with PDAC and underwent resection with curative intent. Retrospective review of the patients was performed based on electronic medical records system. One patient without records of numerical rating scale (NRS) pain intensity scores was excluded and eight patients who underwent total pancreatectomy were also excluded. NRS scores during 7 postoperative days following resection of PDAC were reviewed along with clinicopathologic characteristics. Patients were stratified into a good pain control group and a poor pain control group according to the difference in average pain intensity between the early (POD 1, 2, 3) and late (POD 5, 7) postoperative periods. Cox-proportional hazards multivariate analysis was performed to determine association between postoperative pain control and oncologic outcomes.RESULTSA total of 212 patients were dichotomized into good pain control group (n = 162) and poor pain control group (n = 66). Median follow-up period was 17 mo. A negative impact of poor postoperative pain control on overall survival (OS) was observed in the group of patients receiving distal pancreatectomy (DP group; 42.0 mo vs 5.0 mo, P = 0.001). Poor postoperative pain control was also associated with poor disease-free survival (DFS) in the DP group (18.0 mo vs 8.0 mo, P = 0.001). Patients undergoing pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy (PD group) did not show associations between postoperative pain control and oncologic outcomes. Poor patients’ perceived pain control was revealed as an independent risk factor of both DFS (HR = 4.157; 95%CI: 1.938-8.915; P < 0.001) and OS (HR = 4.741; 95%CI: 2.214-10.153; P < 0.001) in resected left-sided pancreatic cancer.CONCLUSIONAdequate postoperative pain relief during the early postoperative period has important clinical implications for oncologic outcomes after resection of left-sided pancreatic cancer.

Opioid-free versus opioid-based anesthesia in pancreatic surgery

“…Recent reviews have emphasized the importance of the perioperative period on oncologic outcome after cancer surgery [ 4 ]. Indeed, the biological perturbations that accompany the surgical stress response and the pharmacological effects of anesthetic drugs, paradoxically, can promote disease recurrence or the progression of metastatic disease.…”

Opioid-Free Versus Opioid-Based Anesthesia in Pancreatic Surgery

“…In our setting, reduced LOS with OFA did not lead to the unintended consequence of increasing readmission rates, neither in an increased 30-day mortality or unexpected post-discharge complication. It is however too early to identify long-term bene t such as improved disease-free or overall survival due to the limited follow-up (upmost 13 months) [4,34].…”

“…There were no differences in demographics, operative time, blood loss, bradycardia, vasopressors administration or time to extubation among groups.Conclusions: In this series, OFA during pancreatic resection is feasible and independently associated with a better outcome, in particular pain outcomes. The lower rate of postoperative complications may justify future randomized trials to test the hypothesis that OFA may improve outcomes and shorten length of stay.Recent reviews have emphasized the importance of the perioperative period on oncologic outcome after cancer surgery [4]. Indeed, the biological perturbations that accompany the surgical stress response and the pharmacological effects of anesthetic drugs, paradoxically, can promote disease recurrence or the progression of metastatic disease, possibly linked to the suppression of natural killer cell activity, which may be particularly important after pancreatectomy [5][6][7].…”

“…Many perioperative risk factors that can modulate surgery-induced immunosuppression have been suggested such as anesthetic technique, analgesic agents, blood transfusion, hypothermia, and pain. On this matter, adequate postoperative pain relief during the early postoperative period seems to carry the greatest clinical implications for oncologic outcomes after pancreatic resection [4,5]. On the other hand, concerns have grown about unnecessary opioid use [8].…”

“…Recent reviews have emphasized the importance of the perioperative period on oncologic outcome after cancer surgery [4]. Indeed, the biological perturbations that accompany the surgical stress response and the pharmacological effects of anesthetic drugs, paradoxically, can promote disease recurrence or the progression of metastatic disease, possibly linked to the suppression of natural killer cell activity, which may be particularly important after pancreatectomy [5][6][7].…”