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28 August 2008
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Cancer recurrence reduced when epidural analgesia used in prostatectomy
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MedWire News: Combining an epidural analgesic with general anesthesia during radical prostatectomy reduces the risk for prostate cancer recurrence compared with general anesthesia and opioid analgesics, research has shown.
"After adjusting for confounding factors, patients who received general anesthesia combined with epidural analgesia had a 57% lower risk of cancer recurrence than patients who had general anesthesia and postoperative opioids," write Barbara Biki (Mater Misericordiae University Hospital, Dublin, Ireland) and colleagues in the journal Anesthesiology.
Cancer recurrence occurs in a significant fraction of patients after surgical removal of the tumor, possibly because tumor cells are released into the lymphatic and blood streams, explain the researchers. Immunity against these tumor cells, however, is impaired by the surgery itself, and by the use of anesthesia and opioid analgesics, both of which impair natural killer (NK) cells and other immune functions.
"When regional anesthesia and general anesthesia are combined, the amount of general anesthetic required is much reduced - as is, presumably, immune suppression," write the researchers.
In this study, they compared the two anesthetic techniques in 225 patients with invasive prostate carcinoma who underwent surgery to remove the prostate gland. Compared with those who received postoperative opioids plus general anesthesia, patients who received an epidural combined with general anesthetic had a 57% lower risk for cancer recurrence as defined by prostate-specific antigen (PSA) measurements.
The patients in the study groups were not well matched, with epidural patients having worse physical status, more complications, and slightly shorter surgeries, but a propensity-matched analysis on a smaller subset of patients showed the same significant reduction in cancer recurrence with the epidural and anesthesia.
Biki and colleagues speculate that the decrease in cancer recurrence is due to better immune competence to fight the tumor cells that are released during cancer surgery. "Regional anesthesia and analgesia may help to preserve immune function by attenuating the surgical stress response, decreasing anesthetic requirement, and diminishing the need for opioids," the researchers comment.
Anesthesiology 2008; 109: 180-7
http://www.anesthesiology.org/pt/re/anes/abstract.00000542-200808000-00006.htm;jsessionid=L1rd1jbLJzF695m7gmP1NnfbJpx7yhrLKnHZF1fL1YJsp1xGpGyh!1270838445!181195628!8091!-1?index=1&database=ppvovft&results=1&count=10&searchid=1&nav=search
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