An analysis of the survival impact of dexmedetomidine in children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Abstract

Objective: Recent evidence suggests the a2-adrenoreceptor agonist dexmedetomidine may promote metastasis of cancer cells. In this study we sought to evaluate the impact of dexmedetomidine administration on the survival of children and adolescents with cancer. Design: Retrospective chart review. Setting: Comprehensive cancer center. Patients: Children and adolescents who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Intervention: Intraoperative and/or early postoperative (within 24 hours of surgery) administration of dexmedetomidine. Measurements: Multivariable cox proportional hazard models were used to assess the association between dexmedetomidine administration and progression free survival (PFS) or overall survival (OS). Main results: Ninety-three patients were identified. The median age was 12 years, 42% were female, and 35% received dexmedetomidine. There were no significant differences between the baseline and perioperative characteristics of patients who received dexmedetomidine and those who did not. In the multivariable analysis, the administration of dexmedetomidine was not associated with PFS (HR ¼ 1.20, 95% CI [0.60-2.41], p ¼ .606) or OS (HR ¼ 0.81, 95% CI [0.35-1.85], p ¼ .611). Conclusion:In this retrospective study of children and adolescents who had undergone a major oncologic surgery, the intraoperative and/or early postoperative administration of dexmedetomidine was not associated with survival.

Effect of Dexmedetomidine on Biochemical Recurrence in Patients after Robot-Assisted Laparoscopic Radical Prostatectomy: A Retrospective Study

“…The median intraoperative administered doses of dexmedetomidine in the two previous trials on patients with lung cancer were 100 μg (57.47–140 μg) [ 16 ] and 122 μg (118–146 μg) [ 17 ], both of which are higher doses than that used in this study. Pascal et al, who reported findings that were consistent with our findings, used a dose of 0.1–0.7 μg/kg/h [ 19 ]. These inconsistent findings further indicate a mixed survival effect of low-dose dexmedetomidine.…”

“…Based on the data of the previous randomized controlled trials [ 19 , 20 ], this study showed that dexmedetomidine did not significantly affect BCR and radiographic progression in patients with prostate cancer within 4–6 years after RALP. Previous findings regarding this topic have been inconsistent, and the effect of dexmedetomidine on prostate cancer cell lines remains unclear.…”

“…Recently, dexmedetomidine was reported to inhibit esophageal cancer progression via the miR-143-3P/epidermal growth factor receptor pathway substrate 8 in vivo [ 7 ]. Additionally, Owuso et al performed a retrospective study on patients who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and demonstrated that intraoperative and/or early postoperative continuous infusion of dexmedetomidine was not associated with survival [ 19 ]. Apart from the present retrospective analysis and the aforementioned propensity score-matched retrospective study on patients with non-small cell lung cancer [ 16 ], there has not been any randomized trial to evaluate the influence of dexmedetomidine on long-term cancer outcomes.…”

“…However, results of in vitro and in vivo studies of dexmedetomidine revealed that tumor cell proliferation and metastasis are promoted, and overall survival is reduced [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. In contrast, Owuso et al reported that dexmedetomidine did not affect the survival of patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis [ 19 ]. Hence, with variable results reported for different types of cancers, the use of dexmedetomidine during cancer surgery is currently debatable; this may be attributed to a lack of robust prospective data.…”

How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence

“…The dissemination of cancer cells from primary tumors and subsequent seeding of new tumor colonies in distant tissues involves a multistep process known as the invasion-metastasis cascade, in which the Src system seems to play an important role [42]. Lidocaine at clinically achievable concentrations has been shown in vitro to statistically inhibit the phosphorylation of Src and the ICAM-1 expression in human lung cancer cells [43]. This study also demonstrated that the effect was independent of the function of the sodium ion channel.…”