Return to intended oncologic therapy: a potentially valuable endpoint for perioperative research in cancer patients?

Finnerty, Dylan; Buggy, Donal J.

doi:10.1016/j.bja.2020.02.013

Cited by 12 publications

(8 citation statements)

References 21 publications

(14 reference statements)

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“…One large trial in patients undergoing breast cancer surgery has been performed and found no benefit of paravertebral block. 23 Recently, RIOT has been discussed as an important landmark for prediction of long-term outcome after ovarian cancer surgery 7 and colorectal cancer surgery. 6 In the present study, we did not find a significant difference in the time to RIOT or the percentage of patients who could return to adjuvant oncologic therapy within 8 weeks after surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Therefore, return to intended oncologic therapy (RIOT) might be a useful endpoint investigating analgesic methods. 7 , 8 Evidence that TEA might prolong overall and disease-free survival after surgery for colorectal surgery remains unclear and contradictory, and is based solely on retrospective studies, 9 , 10 , 11 as there are no prospective RCTs investigating survival after colorectal cancer surgery with or without TEA to our knowledge.…”

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confidence: 99%

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Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Falk

Magnuson

Eintrei

et al. 2021

British Journal of Anaesthesia

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Background: Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory. Methods: In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT). Results: We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74e2.32), P¼0.35; adjusted HR: 1.19 (95% CI: 0.61e2.31), P¼0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups. Conclusions: There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Falk

Magnuson

Eintrei

et al. 2021

British Journal of Anaesthesia

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“…The concept of return to intended oncologic treatment (RIOT) was recently proposed [ 45 ], as a novel quality metric for oncological anaesthesia and surgery. Both anaesthetic and surgical strategies, developed in order to reduce potentially avoidable postoperative complications, to enhance recovery and to improve RIOT in oncologic patients with different types of solid tumours, were investigated and proposed [ 46 , 47 , 48 ].…”

Section: Hyperoxia Effects On Surgical Cancer Patients—clinical and Experimental Datamentioning

confidence: 99%

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

Ristescu

Tiron

et al. 2021

Biomedicines

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Increased inspiratory oxygen concentration is constantly used during the perioperative period of cancer patients to prevent the potential development of hypoxemia and to provide an adequate oxygen transport to the organs, tissues and cells. Although the primary tumours are surgically removed, the effects of perioperative hyperoxia exposure on distal micro-metastases and on circulating cancer cells can potentially play a role in cancer progression or recurrence. In clinical trials, hyperoxia seems to increase the rate of postoperative complications and, by delaying postoperative recovery, it can alter the return to intended oncological treatment. The effects of supplemental oxygen on the long-term mortality of surgical cancer patients offer, at this point, conflicting results. In experimental studies, hyperoxia effects on cancer biology were explored following multiple pathways. In cancer cell cultures and animal models, hyperoxia increases the production of reactive oxygen species (ROS) and increases the oxidative stress. These can be followed by the induction of the expression of Brain-derived neurotrophic factor (BDNF) and other molecules involved in angiogenesis and by the promotion of various degrees of epithelial mesenchymal transition (EMT).

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“…We should be collecting quality outcome measures of access to care, length of stay, peri-operative morbidity, patient-reported outcomes such as quality of recovery scores, 3 and for cancer, oncological outcomes such as time to resumption of oncological therapy. 4,5 Davis et al provide us with a broad assessment allowing a benchmark for individual comparison. However, the limitation in drawing conclusions from such a broad administrative database, when trying to extrapolate across different indications for surgery is highlighted by this analysis.…”

mentioning

confidence: 99%

“…Using mortality as the prime measure of outcome is inadequate for assessing gastrectomy procedures. We should be collecting quality outcome measures of access to care, length of stay, peri‐operative morbidity, patient‐reported outcomes such as quality of recovery scores, 3 and for cancer, oncological outcomes such as time to resumption of oncological therapy 4,5 …”

mentioning

confidence: 99%

It's time we measure more than Australia's gastrectomy mortality rate

Johnson

Winter

Smithers

2022

ANZ Journal of Surgery

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Return to intended oncologic therapy: a potentially valuable endpoint for perioperative research in cancer patients?

Cited by 12 publications

References 21 publications

Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Exploring Hyperoxia Effects in Cancer—From Perioperative Clinical Data to Potential Molecular Mechanisms

It's time we measure more than Australia's gastrectomy mortality rate

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