Anesthetic Technique for Radical Prostatectomy Surgery Affects Cancer Recurrence

Biki, Barbara; Mascha, Edward J.; Moriarty, Denis C.; Fitzpatrick, John M.; Sessler, Daniel I.; Buggy, Donal J.

doi:10.1097/aln.0b013e31817f5b73

Cited by 567 publications

(410 citation statements)

References 46 publications

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“…An alternative explanation for the difference between our result and that observed by Biki et al 13 (the retrospective study which found that the use of epidural anesthesia conferred a significant survival advantage in prostatectomy) is the relative absence of selection bias in our study. Despite every effort on their part to correct for confounding factors, they would have been unable to correct for biases that were not recorded or were unknown.…”

Section: Discussioncontrasting

confidence: 99%

“…12 Most recently, an analysis of 225 men who underwent open radical prostatectomy for cancer demonstrated a significant association between the use of epidural anesthesia and disease-free survival (hazard ratio for epidural group 0.43) after correcting for a number of known risk factors for recurrence. 13 The authors of these studies all recognized the potential drawbacks of using retrospective data for this purpose and argued that randomized trials should be conducted. Such trials are underway but far from completion.…”

Section: Résumémentioning

confidence: 99%

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Epidural anesthesia and cancer recurrence rates after radical prostatectomy

Tsui

Rashiq

Schopflocher

et al. 2009

Can J Anesth/J Can Anesth

168

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Purpose To determine the effect of adjunctive epidural local anesthetic and opioid infusion on disease recurrence following radical prostatectomy for adenocarcinoma under general anesthesia. Methods This article describes a secondary analysis of subjects undergoing radical prostatectomy who had participated previously in a randomized controlled trial evaluating pain control, blood loss, and the need for perioperative allogeneic blood transfusion. The patients were randomly allocated to receive either general anesthesia alone (control group; n = 50) or combined general/ epidural anesthesia (study group; n = 49). A long-term follow-up chart review was undertaken to determine clinically evident or biochemical (Prostate Specific Antigen [0.2 ng Á mL -1 ) recurrence of prostate cancer. Comparison by group was undertaken using survival analysis.Results Median disease-free survival for the study as a whole was 1644 days, and the longest recorded survival was 3403 days. Biochemical recurrence of prostate cancer was observed in 11/49 study subjects and 17/50 control subjects. There was one death from prostate cancer in each group and a total of five deaths in the study group and six deaths in the control group. The hazard ratio for recurrence in the study group compared with the control group was 1.33 (95% confidence intervals 0.64-2.77; P = 0.44 by log-rank test). Conclusion No difference was observed between the epidural and control groups in disease-free survival at a median follow-up time of 4.5 years. There is a need for large randomized controlled trials to determine the ability of epidural analgesia to alter disease recurrence rates following radical prostatectomy. RésuméObjectif De´terminer l'effet d'une the´rapie adjuvante d'anesthe´sique local pe´ridural et perfusion d'opioı¨des sur la re´currence de la maladie apre`s une prostatectomie radicale pour ade´nocarcinome sous anesthe´sie ge´ne´rale. Méthode Cet article de´crit une analyse secondaire de patients ayant subi une prostatectomie radicale, lesquels avaient pre´ce´demment participe´a`une e´tude randomise´e contrôle´e e´valuant le contrôle de la douleur, les pertes sanguines et le besoin de transfusions sanguines alloge`nes en pe´riode pe´riope´ratoire. Les patients ont e´te´randomise´s a`recevoir soit une anesthe´sie ge´ne´rale seule (groupe te´moin; n = 50) ou une combinaison d'anesthe´sie ge´ne´rale et pe´ridurale (groupe a`l'e´tude; n = 49). Une re´vision des dossiers de suivi a`long terme a e´te´entreprise afin de

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Section: Discussioncontrasting

confidence: 99%

Section: Résumémentioning

confidence: 99%

Epidural anesthesia and cancer recurrence rates after radical prostatectomy

Tsui

Rashiq

Schopflocher

et al. 2009

Can J Anesth/J Can Anesth

168

View full text Add to dashboard Cite

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“…9,10 These findings may therefore imply an association between anesthetic management and long-term outcome. Although NA may reduce the number of postoperative complications and improve short-term mortality in patients undergoing TJR, it remains unknown whether it may also influence long-term survival in these patients.…”

Section: Résumémentioning

confidence: 91%

“…Nous avons créé deux sous-groupes appariés par score de propension, chacun incluant un nombre égal de patients ayant subi une AT sous AG ou AN. (8 [7-10] jours contre 8 [6][7][8][9][10] jours; P = 0,024). Conclusions Nos résultats sont en faveur de l'utilisation de l'AN pour les AT de première intention.…”

Section: Résuméunclassified

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan

Chen

Hung

Tan

et al. 2015

Can J Anesth/J Can Anesth

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Introduction This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. Methods From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-scorematched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA. Results Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P \ 0.001) and shorter median days vs 8 [6-10] days, respectively; P = 0.024). Conclusions Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.

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“…28 (3) Biki et al reported that epidural anesthesia for prostate resection halved recurrence risk. 29 In this issue of the Journal, Tsui et al evaluated biochemical recurrence after prostate cancer resection in 99 patients who were, in the context of a previous study, randomly assigned to general vs epidural anesthesia more than five years ago. 30 Among these patients, 22 were lost to follow-up, leaving 77 patients available for analysis.…”

mentioning

confidence: 99%