Abstract
Objective: There is controversial data regarding influence of anesthetic techniques on the outcome of patients undergoing cancer surgery. In particular, whether patients benefit from the application of regional techniques is elaborately discussed. Therefore we enrolled a retrospective analysis to determine the influence of different anesthetic techniques in patients who underwent radical prostatectomy due to prostate cancer. Methods: After ethics approval, we viewed our medical record archive for patients that received radical prostatectomy between 1995 and 2005 and included 300 patients. They were divided according to their postoperative pain regime (systemic opioids vs. epidural analgesia). Recurrence-free survival was defined as the primary endpoint and overall survival as the secondary endpoint. The study period covered at least the first five post-operative years. Results: We documented no difference in recurrence-free or overall survival comparing the two analgesic regimes. However, we observed that higher body-mass-indexes (BMI) significantly correlated with a worse outcome (recurrence-free survival p=0.037, overall survival p=0.02). Other factors influencing the outcome were the Gleason score (5-6 vs. 10 p=0.016; 7 vs. 10 p=0.08) and surgical margins free of cancer (p=0.04). Conclusion: In this study, different anesthetic techniques did not influence recurrence-free or overall survival rate. Interestingly, we could identify BMI as a risk factor with potential impact on the outcome of patients undergoing radical prostatectomy. Adequately powered prospective randomized trials are required to decide on the effect of regional anesthesia in patients who underwent radical prostatectomy.
Highlights
According to the World Health Organization (WHO), cancer is the second leading cause of death in higher-income countries [1]
Contributing factors for metastases are the release of malignant cells during operation [2,3], pre-existing micrometastases before the operation and a perioperative depression of the immune system as a consequence of the surgical stress response [4,5,6,7]
As several anesthesia-related factors, e.g. opioids and inhalational agents [9,10] have a negative impact on the activity of NK cells, the combination of general and regional anesthesia appears to be a swift way to reduce the perioperative demand for systemic and inhalational agents
Summary
According to the World Health Organization (WHO), cancer is the second leading cause of death in higher-income countries [1]. Already several investigators have tried to determine these effects, but while data for breast cancer [13] and melanoma [14] showed a positive effect of regional anesthesia on the long-term survival, in patients with prostate cancer controversial results were obtained [15,16]. In their retrospective analysis of patients undergoing open radical prostatectomy, Biki and co-workers documented a significant decrease in biochemical cancer recurrence (defined as an increase in prostate-specific antigen, PSA) after 36 months in those men who had an epidural anesthesia in addition to general anesthesia compared to general anesthesia alone [15]. In contrast to the study by Biki, after 10 years no differences in biochemical cancer recurrence were detected
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