The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

Wang, Yu; Wang, Liping; Chen, Hong; Xu, Yang; Zheng, Xiaoyu; Wang, Guonian

doi:10.18632/oncotarget.16724

Cited by 19 publications

(15 citation statements)

References 43 publications

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“…Regional anesthesia also attenuates the release of stress hormones and sympathetic nerve activation [ 16 – 18 ]. Furthermore, several studies reported that epidural anesthesia combined with general anesthesia and epidural analgesia might improve oncologic outcomes in gastric cancer surgery [ 19 ] and resection of colorectal liver metastases [ 20 ]. In the present study, no systemic opioids were used in either the general or regional anesthesia groups because TURB is not a very painful procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effect of spinal anesthesia and general anesthesia on 5-year tumor recurrence rates after transurethral resection of bladder tumors

et al. 2017

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Non-muscle invasive bladder tumors are early-stage tumors with high recurrence rates. Transurethral resection of bladder tumor (TURB) is performed under spinal or general anesthesia; however, the effect of the two anesthetic techniques on non-muscle invasive bladder tumor recurrence is unknown. Thus, we compared their effects on tumor recurrence rates five years after TURB. Data from 876 patients who underwent TURB from 2000 to 2007 was reviewed. Patients received spinal or general anesthesia based on their choice or the clinician's preference. Tumor recurrence five years after TURB was assessed using multivariate Cox regression model, propensity score analysis (matching and inverse probability of treatment weighting), and Kaplan–Meier method. The five-year tumor recurrence rate after TURB was 42% and 53% for spinal and general anesthesia groups, respectively (P = 0.013). Hazard ratios for tumor recurrence in the spinal anesthesia group compared to that in the general anesthesia group were 0.619 (P <0.001), 0.642 (P = 0.001), and 0.636 (P <0.001) in the Cox regression model, Cox regression model with propensity score matching, and adjusted analysis with inverse probability of treatment weighting, respectively. The five-year tumor recurrence rate was significantly lower in the spinal anesthesia group than in the general anesthesia group in both the unadjusted (P = 0.002) and adjusted Kaplan–Meier curves (P <0.001). Therefore, spinal anesthesia for non-muscle invasive bladder tumor resection was associated with a lower five-year tumor recurrence rate than general anesthesia. This finding provides useful information for an appropriate selection of anesthetic technique for TURB.

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Section: Discussionmentioning

confidence: 99%

Comparison of the effect of spinal anesthesia and general anesthesia on 5-year tumor recurrence rates after transurethral resection of bladder tumors

et al. 2017

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“…A more recent retrospective study that compared combined epidural and general anesthesia with general anesthesia alone, reported no difference in long-term survival in gastric cancer patients [ 14 ]. Interestingly, in contrast to the aforementioned negative reports, a recent retrospective study of 4,218 patients by Wang et al [ 15 ] concluded that epidural anesthesia combined with general anesthesia and postoperative epidural PCA may be associated with improved survival after resection for gastric cancer. However, despite having the merit of a largest sample size to date, this study only looked at overall survival, but not cancer recurrence after surgery.…”

Section: Discussionmentioning

confidence: 95%

“…However, a decade later, we are still at a shortage of meaningful evidence to either support or refute this hypothesis. The difficulty of performing a large scale randomized controlled trial (RCT) with a relatively long follow-up period has led us to first look at the available data, and we have been presented with a number of retrospective [ 1 , 2 , 4 – 15 ] and very few prospective [ 6 , 16 ] studies done on the effect of regional anesthesia and/or analgesia on the prognosis of different types of cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Among several regional techniques, epidural analgesia is the most commonly employed method for operations performed in the abdominopelvic region. While there is relative abundance of retrospective and observational studies done on the effect of epidural analgesia in prostate [ 1 , 5 , 6 , 8 , 17 – 20 ] and colorectal cancer, [ 12 , 13 , 21 – 24 ] there are only a few that investigate gastric cancer, [ 4 , 14 , 15 , 25 ] despite it being the fifth most common cancer worldwide. Moreover, not only do the existing studies report inconsistent results, most are based on the data of an insufficient number of a rather heterogeneous group of patients.…”

Section: Introductionmentioning

confidence: 99%

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Effect of postoperative analgesia technique on the prognosis of gastric cancer: a retrospective analysis

Shin

Kim

et al. 2017

Oncotarget

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BackgroundWhether regional analgesia techniques have favorable impact on prognosis after cancer surgery is unclear, and existing reports show controversial results. The aim of the present study was to evaluate and compare recurrence and mortality between patients that received either intravenous (IV) or epidural patient controlled analgesia (PCA) for pain control after curative surgery for gastric cancer.Materials and methodsMedical records of patients that underwent curative gastrectomy for gastric cancer between November 2005 and December 2010 were reviewed. Identified patients were categorized according to the use of IV or epidural PCA for postoperative analgesia. Demographic and perioperative variables including type of PCA were analyzed by univariate and multiple regression analysis to investigate any association with recurrence and mortality after surgery. Propensity score matching was done to adjust for selection bias.ResultsOf the 3,799 patients included in this analysis, 374 and 3, 425 patients received IV and epidural PCAs, respectively. No difference in recurrence (HR, 1.092; 95% CI 0.859 to 1.388; P = 0.471) or mortality (HR, 0.695; 95% CI 0.429 to 1.125; P = 0.138) was identified between the use of IV and epidural PCA. Propensity score matching also showed no difference in recurrence (HR, 1.098; 95% CI 0.756 to 1.596; P = 0.623) or mortality (HR, 0.855; 95% CI 0.391 to 1.869; P = 0.695) between the two groups.ConclusionsPostoperative use of epidural analgesia was not found to be associated with reduced recurrence or mortality after curative surgery in gastric cancer patients. This finding needs to be confirmed with prospective studies in the future.

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“…[15,16] We have demonstrated that a combination of general anesthesia and peri-operative epidural use were associated with the improved overall survival in patients in gastric cancer, and the mechanism was presumed to be that local anesthesia can block the afferent neural input, reduce opioid volume which lead to immunosuppression. [17]So we designed this study to explore the interaction between epidural use and, cytokines of patients in gastric cancer. Anesthesia technique and grouping method: On arrival at the operating room, patients were monitored with electrocardiogram, blood pressure, as well as pulse oximetry.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Epidural Anesthesia and Analgesia on Cluster of Differentiation and Cytokines in Patients after Gastric Cancer Resection

Liang

Wang

Hong

et al. 2018

Preprint

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Background: Epidural use can prevent peri-operative neuro-endocrine stress responses, improve pain after surgery, and reduce opioid volume which lead to immunosuppression. Methods: Forty cases of patients with gastric cancer were finally enrolled into the study. Patients who received general anesthesia (GA group, n=20), a combination of general anesthesia and peri-operative epidural use (EGA group, n=20), were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the first passage of flatus time and incidence of postoperative nausea and vomiting (PONV). We also collected the Cluster of Differentiation (CD)3+, CD4+, CD8+, CD4+/CD8+, Interleukin (IL)-4, IL-6, Interferon (IFN)-γ before surgery, as well as the postoperative days 1, 3 ,7. Results: VAS scores and PONV in GA group were higher than EGA group in the postoperative 3 days. CD3+, CD4+, CD4+/CD8+ were declined in the postoperative 3 days, and nearly recovered to the baseline in the seventh days after surgery in both of the two groups. CD3+ in the GA group decreased more than EGA group. IL-4, IL-6, IFN-γ were increased in the postoperative 3 days, and nearly recovered to the baseline in the seventh days after surgery in both of the two groups, IL-4, IL-6 in the GA group increased more than EGA group. IFN-γ in the EGA group increased more than GA group. Conclusions: A combination of general anesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection.

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The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection: a retrospective study

Cited by 19 publications

References 43 publications

Comparison of the effect of spinal anesthesia and general anesthesia on 5-year tumor recurrence rates after transurethral resection of bladder tumors

Comparison of the effect of spinal anesthesia and general anesthesia on 5-year tumor recurrence rates after transurethral resection of bladder tumors

Effect of postoperative analgesia technique on the prognosis of gastric cancer: a retrospective analysis

The Effects of Epidural Anesthesia and Analgesia on Cluster of Differentiation and Cytokines in Patients after Gastric Cancer Resection

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