Increasing survival rates from cancer with regional anesthesia

[wtbcrna, MSN, DNP, CRNA]

Reg Anesth Pain Med. 2013 Jul 22. [Epub ahead of print]

[h=1]Cervical Epidural Anesthesia Is Associated With Increased Cancer-Free Survival in Laryngeal and Hypopharyngeal Cancer Surgery: A Retrospective Propensity-Matched Analysis.[/h]

Merquiol F, Montelimard AS, Nourissat A, Molliex S, Zufferey PJ.

[h=3]Source[/h]From the *Department of Anesthesiology and Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne cedex; and †Public Health Department, Institut de Cancerologie de la Loire, Saint-Priest en Jarez, France.

[h=3]Abstract[/h][h=4]BACKGROUND AND OBJECTIVES:[/h]Regional anesthesia preserves perioperative immune competence and may reduce the risk of recurrence and metastasis after cancer surgery. Cervical epidural anesthesia provides adequate analgesia for head and neck cancer surgery, but its impact on cancer recurrence is unknown.

[h=4]METHODS:[/h]This study was a single-center retrospective cohort study of patients undergoing larynx or hypopharynx cancer surgery between January 1984 and December 2008. One hundred eleven patients had general anesthesia combined with intraoperative and postoperative cervical epidural; 160 had general anesthesia alone with postoperative morphine. From this cohort, matched pairs were selected using a propensity score to balance potential confounders of receiving epidural anesthesia. The primary end point was the length of cancer-free survival after surgery until September 2009.

[h=4]RESULTS:[/h]Propensity-based matching produced 65 pairs. Matching was effective in achieving balance between groups for each of the preoperative variables collected. Combined epidural and general anesthesia (68% 5-year cancer-free survival; 95% confidence interval [CI], 57%-82%) was associated with significantly increased cancer-free survival compared with general anesthesia alone (37% 5-year cancer-free survival; 95% CI, 25%-54%) with a corresponding adjusted hazard ratio of 0.49 (95% CI, 0.25-0.96; P = 0.04). Patients in the epidural group had an increased overall survival compared with the non-epidural group (P = 0.03).

[h=4]CONCLUSIONS:[/h]The association between cervical epidural anesthesia and increased cancer-free survival found in this retrospective study should be an important hypothesis to further investigate in head and neck cancer surgery.

Int J Physiol Pathophysiol Pharmacol. 2013;5(1):1-10. Epub 2013 Mar 8.

[h=1]The effects of anesthetics on tumor progression.[/h]Mao L, Lin S, Lin J.

[h=3]Source[/h]Department of Anesthesiology, SUNY Downstate Medical Center 450 Clarkson Avenue, Box 6, Brooklyn, New York 11203-2098, USA.

[h=3]Abstract[/h]More and more cancer patients receive surgery and chronic pain control. Cell-mediated immunosuppression from surgical stress renders perioperative period a vulnerable period for tumor metastasis. Retrospective studies suggest that regional anesthesia reduces the risk of tumor metastasis and recurrence. This benefit may be due to the attenuation of immunosuppression by regional anesthesia. On the other hand, accumulating evidence points to a direct role of anesthetics in tumor progression. A variety of malignancies exhibit increased activity of voltage-gated sodium channels. Blockade of these channels by local anesthetics may help inhibit tumor progression. Opioids promote angiogenesis, cancer cell proliferation and metastasis. It will be interesting to examine the therapeutic potential of peripheral opioid antagonists against malignancy. Volatile anesthetics are organ-protective against hypoxia, however; this very protective mechanism may lead to tumor growth and poor prognosis. In this review, we examine the direct effects of anesthetics in tumor progression in hope that a thorough understanding will help to select the optimal anesthetic regimens for better outcomes in cancer patients.

Anesthesiology:

August 2008 - Volume 109 - Issue 2 - pp 180-187

doi: 10.1097/ALN.0b013e31817f5b73

Perioperative Medicine

[h=2]Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer Recurrence: A Retrospective Analysis[/h][h=3]Biki, Barbara M.D.*; Mascha, Edward Ph.D.†; Moriarty, Denis C. M.D.‡; Fitzpatrick, John M. M.D.; Sessler, Daniel I. M.D.∥; Buggy, Donal J. M.D., M.Sc., F.R.C.P.I., F.C.A.R.C.S.I., F.R.C.A.#

[/h]

[h=4]Abstract[/h]

Background: Regional anesthesia and analgesia attenuate or prevent perioperative factors that favor minimal residual disease after removal of the primary carcinoma. Therefore, the authors evaluated prostate cancer recurrence in patients who received either general anesthesia with epidural anesthesia/analgesia or general anesthesia with postoperative opioid analgesia.

Methods: In a retrospective review of medical records, patients with invasive prostatic carcinoma who underwent open radical prostatectomy between January 1994 and December 2003 and had either general anesthesia-epidural analgesia or general anesthesia-opioid analgesia were evaluated through October 2006. The endpoint was an increase in postoperative prostate-specific antigen.

Results: After adjusting for tumor size, Gleason score, preoperative prostate-specific antigen, margin, and date of surgery, the epidural plus general anesthesia group had an estimated 57% (95% confidence interval, 17-78%) lower risk of recurrence compared with the general anesthesia plus opioids group, with a corresponding hazard ratio of 0.43 (95% confidence interval, 0.22-0.83; P = 0.012) in a multivariable Cox regression model. Gleason score and tumor size (percent of prostate involved) were also independent predictors of recurrence (hazards ratios of 1.19 [1.08, 1.52], P = 0.004, and 1.17 [1.03, 1.34] for 10% size difference, P = 0.01, respectively). A similar association between epidural use and recurrence was obtained by comparing patients matched on the propensity to receive epidural versus general anesthesia.

Conclusions: Open prostatectomy surgery with general anesthesia, substituting epidural analgesia for postoperative opioids, was associated with substantially less risk of biochemical cancer recurrence. Prospective randomized trials to evaluate this association seem warranted.

[ruler of kolob]

I had read articles about the relationship between regional anesthesia and cancer survival , and heard some talks at NYSSA etc. I do epidurals for open prostatectomies, low anterior resections, cystectomines w/wo neobladder creation etc.

What I had never heard of was regional for neck surgeries. While the study is lacking in more than a few areas...It did pique my interest in regional for neck surg.