Abstract
The usage of dexmedetomidine during cancer surgery in current clinical practice is debatable, largely owing to the differing reports of its efficacy based on cancer type. This study aimed to investigate the effects of dexmedetomidine on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer, who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). Using follow-up data from two prospective randomized controlled studies, BCR and radiographic progression were compared between individuals who received dexmedetomidine (n = 58) and those who received saline (n = 56). Patients with complete follow-up records between July 2013 and June 2019 were enrolled in this study. There were no significant between-group differences in the number of patients who developed BCR and those who showed positive radiographic progression. Based on the Cox regression analysis, age (p = 0.015), Gleason score ≥ 8 (p < 0.001), and pathological tumor stage 3a and 3b (both p < 0.001) were shown to be significant predictors of post-RALP BCR. However, there was no impact on the dexmedetomidine or control groups. Low-dose administration of dexmedetomidine at a rate of 0.3–0.4 μg/kg/h did not significantly affect BCR incidence following RALP. In addition, no beneficial effect was noted on radiographic progression.
Highlights
Several reports have highlighted the importance of understanding and defining various factors during the perioperative period that may affect the postoperative long-term outcomes of patients with cancer [1,2]
biochemical recurrence (BCR), radiographic progression status, initial prostate-specific antigen (PSA) levels, Gleason score, tumor volume, surgical margin status, pathological tumor stage, and lymph node metastasis were included as variables in this study
A study on a mouse model of lung cancer has demonstrated that dexmedetomidine promoted postoperative metastasis by augmenting the number of monocytic myeloid-derived suppressor cells (M-MDSCs) via alpha-2 adrenoreceptor stimulation [17], and in vitro study suggested that dexmedetomidine promotes cancer cell survival in lung cancer through signaling via on alpha-2 adrenoreceptor [18]
Summary
Several reports have highlighted the importance of understanding and defining various factors during the perioperative period that may affect the postoperative long-term outcomes of patients with cancer [1,2]. The anesthetic and analgesic approaches are prominent aspects of surgery that may be manipulated to improve various endocrinological, immunological, and cancer-related outcomes [2,3,4]. Clinical studies on the effect of dexmedetomidine, an alpha-2 adrenoreceptor agonist commonly used in the perioperative period, have been performed for several types of cancer. The effects elicited by dexmedetomidine, the sympatholytic effects, are suggestive of its benefits in the perioperative care of patients with cancer [5,6]. A recent in vivo study has shown that dexmedetomidine inhibits esophageal cancer progression via miR-143-3P/epidermal growth factor receptor pathway substrate 8 [7]
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