Anesthetic technique for radical prostatectomy surgery affects cancer recurrence - A retrospective analysis

被引:480
作者
Biki, Barbara [1 ]
Mascha, Edward [2 ]
Moriarty, Denis C. [3 ]
Fitzpatrick, John M. [3 ]
Sessler, Daniel I. [4 ]
Buggy, Donal J. [1 ]
机构
[1] Mater Misericordiae Univ Hosp, Dept Anaesthesia, Dublin 7, Ireland
[2] Cleveland Clin, Dept Quantitat Hlth Sci & Outcomes Res, Cleveland, OH USA
[3] Univ Coll Dublin, Dublin, Ireland
[4] Cleveland Clin, Dept Outcomes Res, Cleveland, OH USA
关键词
D O I
10.1097/ALN.0b013e31817f5b73
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Regional anesthesia and analgesia attenuate or prevent perioperative factors that favor minimal residual disease after removal of the primary carcinoma. Therefore, the authors evaluated prostate cancer recurrence in patients who received either general anesthesia with epidural anesthesia/analgesia or general anesthesia with postoperative opioid analgesia. Methods: In a retrospective review of medical records, patients with invasive prostatic carcinoma who underwent open radical prostatectomy between January 1994 and December 2003 and had either general anesthesia-epidural analgesia or general anesthesia-opioid analgesia were evaluated through October 2006. The endpoint was an increase in postoperative prostate-specific antigen. Results: After adjusting for tumor size, Gleason score, preoperative prostate-specific antigen, margin, and date of surgery, the epidural plus general anesthesia group had an estimated 57% (95% confidence interval, 17-78%) lower risk of recurrence compared with the general anesthesia plus opioids group, with a corresponding hazard ratio of 0.43 (95% confidence interval, 0.22-0.83; P = 0.012) in a multivariable Cox regression model. Gleason score and tumor size (percent of prostate involved) were also independent predictors of recurrence (hazards ratios of 1.19 [1.08, 1.52], P = 0.004, and 1.17 [1.03, 1.34] for 10% size difference, P = 0.01, respectively). A similar association between epidural use and recurrence was obtained by comparing patients matched on the propensity to receive epidural versus general anesthesia. Conclusions: Open prostatectomy surgery with general anesthesia, substituting epidural analgesia for postoperative opioids, was associated with substantially less risk of biochemical cancer recurrence. Prospective randomized trials to evaluate this association seem warranted.
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收藏
页码:180 / 187
页数:8
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