Paravertebral Block Does Not Reduce Cancer Recurrence, but Is Related to Higher Overall Survival in Lung Cancer Surgery: A Retrospective Cohort Study

Lee, Eun Kyung; Ahn, Hyun Joo; Zo, Jae Ill; Kim, Kyunga; Jung, Dae Myung; Park, Joo Hyun

doi:10.1213/ane.0000000000002342

Cited by 35 publications

(25 citation statements)

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“…Postoperative analgesic methods are suggested to have an impact on long term prognosis after cancer surgery through opioid-induced immune suppression. Lee et al (2017) report analysis results comparing the recurrence-free survival (RFS), defined as time to cancer recurrence or death, from surgery among three analgesic methods ( K = 3): intravenous patient controlled analgesia (PCA, group 1), paravertebral block (PVB, group 2), and thoracic epidural analgesia (TEA, group 3), for lung cancer surgery. Excluding cases with missing data, our analysis includes a total of 363 patients (111 for PCA, 137 for PVB, and 115 for TEA) among whom 111 patients had disease recurrence.…”

Section: Numerical Studiesmentioning

confidence: 99%

“…Decision tree analysis of Lee et al (2017). Each leaf denoting a stratum has frequencies of treatment groups of PCA, PVB, and TEA.…”

Section: Figurementioning

confidence: 99%

“…) are similar to the weighted Kaplan-Meier curves ofFigure 2a, while those of PVB and TEA groups using decision tree method (Figure 3b) are more separated than the corresponding weighted Kaplan-Meier curves inFigure 2b. Using the propensity scores from multinomial logistic regression, the matched data have Decision tree analysis ofLee et al (2017). Each leaf denoting a stratum has frequencies of treatment groups of PCA, Weighted Kaplan-Meier curves: (a) Using multinomial logistic regression and (b) using decision tree method…”

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confidence: 99%

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K‐Sample comparisons using propensity analysis

Jung

Ahn

2019

Biometrical J

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In this paper, we investigate K-group comparisons on survival endpoints for observational studies. In clinical databases for observational studies, treatment for patients are chosen with probabilities varying depending on their baseline characteristics. This often results in non-comparable treatment groups because of imbalance in baseline characteristics of patients among treatment groups. In order to overcome this issue, we conduct propensity analysis and match the subjects with similar propensity scores across treatment groups or compare weighted group means (or weighted survival curves for censored outcome variables) using the inverse probability weighting (IPW). To this end, multinomial logistic regression has been a popular propensity analysis method to estimate the weights. We propose to use decision tree method as an alternative propensity analysis due to its simplicity and robustness. We also propose IPW rank statistics, called Dunnett-type test and ANOVA-type test, to compare 3 or more treatment groups on survival endpoints. Using simulations, we evaluate the finite sample performance of the weighted rank statistics combined with these propensity analysis methods. We demonstrate these methods with a real data example. The IPW method also allows us for unbiased estimation of population parameters of each treatment group. In this paper, we limit our discussions to survival outcomes, but all the methods can be easily modified for any type of outcomes, such as binary or continuous variables.

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Section: Numerical Studiesmentioning

confidence: 99%

“…Decision tree analysis of Lee et al (2017). Each leaf denoting a stratum has frequencies of treatment groups of PCA, PVB, and TEA.…”

Section: Figurementioning

confidence: 99%

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confidence: 99%

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K‐Sample comparisons using propensity analysis

Jung

Ahn

2019

Biometrical J

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“…Nerve block anesthesia such as paravertebral nerve block has many advantages such as reducing opioids and general anesthetic consumption, reducing the inflammatory response and immunosuppression caused by surgical trauma, and can improve the long-term survival rate of postoperative patients with lung cancer [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of Ultrasound-Guided Paravertebral Block on MMP-9 and Postoperative Pain in Patients Undergoing VATS Lobectomy: A Randomized, Controlled Clinical Trial

Dong

Wang

et al. 2020

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Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block(PVB) combined with general anesthesia(GA) and general anesthesia regarding their effects on matrix metalloproteinase-9 (MMP-9) and postoperative pain after video-assisted thoracoscopic surgery(VATS) lobectomy. Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2 2018 and Sep 28 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcome was pain scores during postoperative 48h. The secondary outcome were plasma concentrations of MMP-9, complications, and duration of postoperative hospital stay. Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n=25) or general anesthesia (n=24). Both groups were similar regarding baseline characteristics. Pain scores were lower at 4h and 24h in PVB/GA group, compared with GA group (2.53±0.83 vs 3.4±0.91; 2.2±0.94 vs 3.0±0.93, respectively, P <0.05). There were no difference at 1h and 48h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy ( P <0.05). Postoperative complications and length of stay did not differ by anesthetic technique. Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

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“…Although general anesthesia is the most commonly used anesthesia method in patients undergoing lung resection, general anesthesia is associated with higher levels of inflammation and has stronger immunosuppression in comparison with regional anesthesia (5). The use of a nerve block technique, such as the paravertebral block by modulating the inflammatory and immune response associated with the surgical trauma, reducing opioid and general anesthetic consumption, could be associated with improvements in long-term survival after lung cancer surgery (6).…”

Section: Introductionmentioning

confidence: 99%

Effects of Ultrasound-Guided Paravertebral Block on MMP-9 and Postoperative Pain in Patients Undergoing VATS Lobectomy: A Randomized, Controlled Clinical Trial

Dong

Wang

et al. 2019

Preprint

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Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block(PVB) combined with general anesthesia(GA) and general anesthesia regarding their effects on matrix metalloproteinase-9 (MMP-9) and postoperative pain after video-assisted thoracoscopic surgery(VATS) lobectomy.Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2 2018 and Sep 28 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcome was pain scores during postoperative 48h. The secondary outcome were plasma concentrations of MMP-9, complications, and duration of postoperative hospital stay. Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n=25) or general anesthesia (n=24). Both groups were similar regarding baseline characteristics. Pain scores were lower at 4h and 24h in PVB/GA group, compared with GA group (2.53±0.83 vs 3.4±0.91; 2.2±0.94 vs 3.0±0.93, respectively, P<0.05). There were no difference at 1h and 48h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy (P<0.05). Postoperative complications and length of stay did not differ by anesthetic technique.Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

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Paravertebral Block Does Not Reduce Cancer Recurrence, but Is Related to Higher Overall Survival in Lung Cancer Surgery: A Retrospective Cohort Study

Abstract: Pain-control methods are not related to cancer recurrence. However, PVB may have a beneficial effect on overall survival of patients with lung cancer.

Cited by 35 publications

References 19 publications

K‐Sample comparisons using propensity analysis

K‐Sample comparisons using propensity analysis

Effects of Ultrasound-Guided Paravertebral Block on MMP-9 and Postoperative Pain in Patients Undergoing VATS Lobectomy: A Randomized, Controlled Clinical Trial

Effects of Ultrasound-Guided Paravertebral Block on MMP-9 and Postoperative Pain in Patients Undergoing VATS Lobectomy: A Randomized, Controlled Clinical Trial

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