Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in Central Sweden

Gupta, Anil; Björnsson, Andreas; Fredriksson, Mats; Hallböök, Olof; Eintrei, Christina

doi:10.1093/bja/aer100

Cited by 154 publications

(104 citation statements)

References 19 publications

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“…Interest has been focused to local anesthesia (peripheral and central blocks), which has shown beneficial effects on immunity after surgery [147] and may affect surgical outcome of oncologic patients [43, [148][149][150]. Regional anesthesia is believed to be beneficial against cancer recurrence due to reduced exposure to immunosuppressive agents (i.e., nitrous oxide), reduced surgical stress and adrenergic stimulation, but the mechanism is still unclear [147].…”

Section: Does the Type Of Anesthesia Influence The Risk Of Cancer Recmentioning

confidence: 99%

Anesthesia, cytokines and cancer recurrence

Kitamura¹,

Biaso²,

Ingelmo

et al. 2015

Glob Anesth Perioper Med

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Cytokines are essential mediators for the regulation of both innate and acquired immunity and hematopoiesis. They modulate immune cell signaling, activation, adhesion and functioning. They regulate the individual response to several insults such as infection, inflammation, trauma, and pain. Moreover, the balance between pro-inflammatory and anti-inflammatory cytokines is critical for the evolution of surgical complications and tumor progression.Several drugs, including anesthetic agents, influence cytokines secretion. Opioids, inhalational agents, intravenous and local anesthetics have shown different effects on immune system and cytokine expression. Therefore, anesthesia may play an important role in postoperative recovery and outcome of cancer patients.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Furthermore, current clinical evidence regarding the effects of anesthesia on cancer recurrence will be discussed. Cytokines and immune systemCytokines are proteins expressed in both innate and acquired immune system and are often named according to the secreting cells (i.e., lymphocytes, interleukins, etc.). They are essential mediators of the natural (non-specific, innate) immunity, which is the initial step of the inflammatory response. They also play a pivotal role during the specific immunity, which occurs after exposure to antigens, as they regulate lymphocyte and leukocyte activation, growth and differentiation, and the immune-mediated inflammation [1].The cytokines have different structures, but also common aspects, which are summarized in Table 1.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Cytokines receptorsThe cytokines receptors are formed by one or more transmembrane proteins: the extracellular portion binds the cytokine, whereas the cytoplasmic part starts the signal cascade. Based on the extracellular portion, they are divided in five categories. 1) Type I receptors, which have four α-helical stands and contain four cysteine residues and the amino acid motif tryptophanserine-X-tryptophan-serine (WSXWS).2) Type II receptors, structurally similar to Type I receptors, but without the sequence WSXWS. Cytokines functionProvided that the same cytokine may be produced during both innate and acquired immunity response, cytokines can be classified according to their functions: 1)Cytokines regulating the innate immunity and secreted by stimulated macrophages; 2)Cytokines regulating the acquired immunity and secreted by lymphocytes; 3)Cytokines stimulating the hematopoiesiss and secreted by bone marrow, leucocytes and other cells. Common aspects of CytokineTheir secretion is brief and limited in time Cytokine expressed during the innate immunity response Tumor necrosis factor (TNF-α, TNF-β)The TNF is responsible for the initial phase of acute inflammatory response, especially against ...

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Section: Does the Type Of Anesthesia Influence The Risk Of Cancer Recmentioning

confidence: 99%

Anesthesia, cytokines and cancer recurrence

Kitamura¹,

Biaso²,

Ingelmo

et al. 2015

Glob Anesth Perioper Med

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“…In that particular study, no association was found between the use of epidural anesthesia and recurrence-free survival. In a recent study of 655 patients, Gupta et al [17] demonstrated that patients with rectal cancer treated with epidural analgesia had a better overall survival, but those with colon cancer did not (Table 1). These results are similar to those of Christopherson et al [6].…”

Section: Postoperative Neuraxial Analgesia and Gastrointestinal Cancementioning

confidence: 99%

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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“…Bu farkı, epidural ile önlenen nöroendokrin stres cevabın koruyucu etkisinin tümörün tipine göre değişiklik gösterebileceğine bağlamışlardır (6). Tümörün tipi, rekürrens, metastaz ve kanser ile ilişkili mortalitenin en önemli belirleyicisi olduğu vurgulanmıştır.…”

Section: Rekürrensunclassified

Regional Anesthesia and Colorectal Cancer Surgery

Çakirca¹,

Başkan²,

Çakırca³

2013

Acta Oncol Tur.

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ÖZETKolorektal kanser görülme sıklığı yaşla artmaktadır. Geriatrik hastalarda kardiyorespiratuvar ve serebrovasküler sistemlerde eşlik eden hastalıklar daha sık bulunmaktadır. Bu hastalarda yüksek ASA skorları, anatomik zorluklar ve cerrahi riskler anesteziyolojist tarafından yönetilmelidir. Anestetiklerin patofizyolojik etkilerinin daha iyi anlaşılmaya başlanması ile kolorektal kanser cerrahisi geçirecek hastaların anestezisini ve analjezisini sağlamakta rejyonel anestezi teknikleri kullanımı gündeme gelmiştir. Bu yazıda rejyonel anestezi tekniklerinin kolorektal kanser hastalarında uygulamalarının avantaj ve dezavantajları hakkında güncel bilgilerin sunulması amaçlanmıştır. Anahtar Kelimeler: Rejyonel anestezi; kanser ABSTRACT The incidence of colorectal cancer increase with age. Geriatric patients have more comorbid medical conditions including cardiorespiratory and cerebrovascular diseases. Thus, high ASA scores, anatomical deformities and surgical risks should be managed by anesthesiologists. More common using of regional anesthetic tecniques to provide anesthesia and analgesia fort he patients undergoing colorectal cancer surgery has became a current issue with the better understandings on the pathophysiologic effects of the anaesthetic agents. In this article, we aimed to discuss the advantages and disadvantages of regional anesthetic tecniques in patients undergoing colorectal cancer surgery.

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Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in Central Sweden

Abstract: We found a reduction in all-cause mortality after rectal but not colon cancer in patients having EDA compared with PCA technique.

Cited by 154 publications

References 19 publications

Anesthesia, cytokines and cancer recurrence

Anesthesia, cytokines and cancer recurrence

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

Regional Anesthesia and Colorectal Cancer Surgery

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