Analysis of the effects of drugs and techniques used in anesthesia on tumour recurrence, metastasis and survival in ovarian serous adenocarcinoma

Abstract

INTRODUCTIONSurgical removal of the primary tumour is the best treatment option for solid tumours.Studies have shown that cancer related deaths occur mostly due to metastasis. 1 Perioperative period is very critical as a number of factors during this period promote development of metastasis.2 Compromised immune defense and tumour seeding leads to increased susceptibility to tumour metastasis during perioperative period. 3,4 In this context there is increasing interest on the effect of anesthesia and anesthesia techniques in tumour progression suggesting an increased role for the anesthetist in improving long term outcome after cancer surgery. ABSTRACTBackground: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anaesthetic techniques have effects on tumour recurrence. Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingoopherectomy from 1995-2008 were analysed for the effect of anaesthetic techniques and drugs on tumour recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anaesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors. Results: The overall survival rate (RR at 95% CI=3.16(1.79-5.60) was significantly better in patients who received regional anaesthesia for surgery than those who had general anaesthesia. Other factors significantly associated with overall survival rate in univariable analysis were,perioperative blood transfusion,preoperative Ca 125 level, FIGO stage, tumour size and lymphatic metastasis.Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate.Recurrence rate did not show significant difference in univariable(Odds 95% CI 1.42 P = 0.273)and multivariable(Odds 95% CI = 0 P = 0.846) analysis.Al1the 18 patients who had metastasis underwent surgery under GA. Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anaesthesia when compared to those who had surgery under general anaesthesia. Prospective randomized control trials are needed for better evaluation.