Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome

Wuethrich, Patrick Y.; Schmitz, Shu‐Fang Hsu; Kessler, Thomas M.; Thalmann, George N.; Studer, Urs E.; Stueber, Frank; Burkhard, Fiona C.

doi:10.1097/aln.0b013e3181e4f6ec

Cited by 147 publications

(88 citation statements)

References 28 publications

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“…Scavonetto et al [13], Sprung et al [24] and Roiss et al [17] reported HR obtained after matching patients. Both studies from Wuethrich et al [21,23] provided estimates from matched and unmatched patient populations of patients. Regarding OS, only five studies that reported OS were included in the analysis.…”

Section: • Included Studiesmentioning

confidence: 99%

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

et al. 2015

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Aims:To determine whether the use neuraxial anesthesia/analgesia is associated with longer biochemical recurrence-free survival (BRFS) and overall survival (OS) after radical prostatectomy. Methods: Ten studies were included in the meta-analysis. A random-effects model was used to estimate the hazard ratios (HRs). Results: The HR for BRFS was 1.02 (95% CI: 0.91-1.15) for all studies and 1.08 (95% CI: 0.91-1.15) for those that included propensity score matching. For OS, the HR across all studies was 0.91 (95% CI: 0.7-1.15) and 0.81 (95% CI: 0.68-0.96; p = 0.016) for those reporting propensity score matching. Conclusion: The anesthetic technique used during oncologic prostatectomy surgery is not associated with longer BRFS. By contrast, the use of regional analgesia appears to improve OS. KEYWORDS• biochemical recurrence-free survivalProstate cancer is the most common malignancy and the second leading cause of cancer death in males [1]. Radical prostatectomy (RP) has been shown to decrease mortality and is the treatment of choice in many patients with localized cancer [2]. However, ∼25% of patients still develop local recurrence or distant metastasis after primary tumor resection [3]. Recurrences are related to tumor stage, Gleason score, lymph node stage, surgical margin status and preoperative serum prostate-specific antigen level [4,5]. Practice points• Regional anesthesia/analgesia has sparing opioid effects.• Local anesthetics have anti-inflammatory and immune protective effects.• Both, sparing opioid and anti-inflammatory effects have been proposed to be the mechanisms by which regional anesthesia might prolong the survival of cancer patients.• Regional anesthesia/analgesia has shown to reduce cancer recurrence in some retrospective studies but not in other similar clinical reports.• The findings of this study do not support the association between regional anesthesia/analgesia and improved recurrence-free survival after radical prostatectomy.• Regional anesthesia/analgesia is associated with a better overall survival after radical prostatectomy.For reprint orders, please contact: reprints@futuremedicine.com

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Section: • Included Studiesmentioning

confidence: 99%

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

et al. 2015

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“…The use of postoperative epidural analgesia improved biochemical parameters associated with cancer recurrence (rise in prostate-specific antigen after surgery) in the study by Biki et al [2], who included 225 patients, but not in the study by Wuethrich et al [37]. Interestingly, Wuethrich et al [37] identified an improvement in clinical progression survival (defined as the time from surgery to clinical progression or death) but not in cancer-specific and overall survival. Forget et al [15] conducted the largest study that included 1111 patients and found that the use of regional analgesia was not associated with better biochemical recurrence-free survival.…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 98%

“…Six retrospective studies have addressed the question of whether regional analgesia, specifically neuraxial analgesia, has a significant impact on recurrence after genitourologic cancers [2,3,11,15,25,37] (Table 1). The results of three studies conducted in patients with prostate cancer are inconsistent [2,15,37].…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 99%

“…The results of three studies conducted in patients with prostate cancer are inconsistent [2,15,37]. The use of postoperative epidural analgesia improved biochemical parameters associated with cancer recurrence (rise in prostate-specific antigen after surgery) in the study by Biki et al [2], who included 225 patients, but not in the study by Wuethrich et al [37]. Interestingly, Wuethrich et al [37] identified an improvement in clinical progression survival (defined as the time from surgery to clinical progression or death) but not in cancer-specific and overall survival.…”

Section: Postoperative Neuraxial Analgesia and Genitourologic And Gynmentioning

confidence: 99%

See 1 more Smart Citation

Can Regional Anesthesia and Analgesia Prolong Cancer Survival After Orthopaedic Oncologic Surgery?

Cata

Hernandez

Lewis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence. Questions/purposes We performed a systematic review of the literature on the use of regional anesthesia and postoperative analgesia to improve cancer-related survival after oncologic surgery. Our primary topic of interest is survival after orthopaedic oncologic surgery, but because that literature is limited, we also have systematically reviewed the question of survival after breast, gastrointestinal, and genitourologic cancers.

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“…16 Nevertheless, there is substantial challenge to such translational work, and clinical studies have not found a consistent association between opioid-sparing and oncological outcomes. [17][18][19][20][21][22][23][24][25][26][27] One challenge with contemporary anesthetic practices is the impracticality of accomplishing acceptable analgesia without some perioperative opioids. This reality impedes definitive prospective research on whether complete avoidance of perioperative opioids modifies oncological outcomes.…”

mentioning

confidence: 99%

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

Weingarten

Taccolini

Ahle

et al. 2016

Can J Anesth/J Can Anesth

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Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome

Cited by 147 publications

References 28 publications

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

Can Regional Anesthesia and Analgesia Prolong Cancer Survival After Orthopaedic Oncologic Surgery?

Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study

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