Effect of Local Versus General Anesthesia in Breast-Conserving Surgery on Cancer Recurrence and Cost

Abstract

Background The association between the type of anesthesia used and the recurrence of cancer remains controversial. This study aimed to compare the effects of local vs general anesthesia on recurrence-free survival and cost after breast-conserving surgery. Materials and Methods We reviewed the data of 2778 patients who underwent breast-conserving surgery followed by radiation at our center between 1999 and 2014. We analyzed the data of 994 patients with hormone receptor-positive and Her2-negative tumors who underwent breast-conserving surgery without axillary lymph node dissection under local or general anesthesia. Patients were grouped according to whether local or general anesthesia was used for the surgery. Results Of the 994 patients enrolled in this study, 367 received local anesthesia and 627 patients received general anesthesia. The median follow-up duration for all patients was 93 months. The Kaplan–Meier survival curves did not reveal significant differences between the recurrence-free survival of the two groups, with 5-year recurrence-free survival rates of 96.3% (95% CI, 94.3–98.3%) in the local anesthesia group and 97.3% (95% CI, 95.9–98.7%) in the general anesthesia group. The total cost of hospitalization in the local anesthesia group was significantly lower than that in the general anesthesia group ( P <.001). The difference in the cost between the two groups remained significant, irrespective of the type of hospitalization, after excluding 165 patients receiving chemotherapy during their hospitalization. Conclusions Our analysis indicated no association between the type of anesthesia used during breast-conserving surgery and the long-term prognosis of breast cancer. However, breast-conserving surgery under local anesthesia may be a less expensive option than that under general anesthesia.

Impact of anesthesia choice in cutaneous melanoma surgery

“…Although the evidence may not support a strong correlation between the use of general anesthesia and adverse outcomes in melanoma, regional anesthesia and/or spinal blocks in cancer patients do effectively mitigate sympathetic responses in both the intraoperative and postoperative phases [16]. In other cancer types, including prostate, breast, colorectal, and ovarian cancer, these effects are correlated either to improved long-term patient outcomes [64][65][66][67], or no effect [66,[68][69][70], but never to worsened survival [71][72][73], and overall cost savings to the health care system [73]. Ultimately, although definitive clinical evidence regarding the role of general versus regional anesthesia and melanoma outcomes would require a randomized clinical trial, it is unlikely there is sufficient equipoise to justify its establishment.…”

Eficacia anestésica de la infiltración local de lidocaína al 1% más ropivacaína al 0.2% en comparación con lidocaína al 2% en cirugía ambulatoria de mama

“…En cirugía ambulatoria de mama, los estudios que han abordado la eficacia de la lidocaína al 1% con epinefrina también demuestran su seguridad y eficacia [6][7][8][9] . Gu et al 9 compararon el efecto de la anestesia local frente a la general y no encontraron diferencias significativas, por lo que se considera una alternativa viable, independientemente de las combinaciones con lidocaína.…”

Comparisons of different general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer

“…[4][5][6][7][8][9] In modern society, with the exception of satisfying clinical anesthesia, the maintenance of immune function is also extremely important. Many studies involving anesthesia and immunity have focused on general anesthesia and regional anesthesia [10,11] and few studies have specifically explored the effects of different general anesthetic techniques on immune function in oncology patients. Medicine Sevoflurane, a widely used volatile agent, has gained popularity because of its pharmacodynamic and pharmacokinetic properties.…”