Effects of Perioperative Epidural Analgesia on Cancer Recurrence and Survival.

Donghang Zhang,Tao Zhu,Cheng Zhou,Jin Liu,Jingyao Jiang,Han Huang

doi:10.3389/fonc.2021.798435

Donghang Zhang, Tao Zhu + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2021.798435

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Abstract

Surgical resection is the main curative avenue for various cancers. Unfortunately, cancer recurrence following surgery is commonly seen, and typically results in refractory disease and death. Currently, there is no consensus whether perioperative epidural analgesia (EA), including intraoperative and postoperative epidural analgesia, is beneficial or harmful on cancer recurrence and survival. Although controversial, mounting evidence from both clinical and animal studies have reported perioperative EA can improve cancer recurrence and survival via many aspects, including modulating the immune/inflammation response and reducing the use of anesthetic agents like inhalation anesthetics and opioids, which are independent risk factors for cancer recurrence. However, these results depend on the cancer types, cancer staging, patients age, opioids use, and the duration of follow-up. This review will summarize the effects of perioperative EA on the oncological outcomes of patients after cancer surgery.

Highlights

Cancer has become a major cause of death worldwide, while metastasis and/or recurrence is the major cause of death from cancer [1,2,3]
Gottschalk et al showed that, perioperative epidural analgesia (EA) for colorectal cancer surgery did not improve cancer recurrence with a median follow-up time of 1.8 years, a potential benefit was observed in older patients (> 64 years old) [15]. These findings suggest that the effects of perioperative EA on oncological outcomes after colorectal cancer surgery may be related to the cancer types, stage, patients’ age, and surgery approach, which need further well-designed studies to determine
The results showed that compared with general anesthesia alone, combined general anesthesia with perioperative EA was associated with worse recurrence and disease-free survival for bladder cancer surgeries with 41.4 months follow-up [41], which may be due to the increased opioids use

Summary

INTRODUCTION

Cancer has become a major cause of death worldwide, while metastasis and/or recurrence is the major cause of death from cancer [1,2,3]. The surgical process is associated with immunosuppression, which may generate a high vulnerability for tumor worse progression [4,5,6] Several drugs, such as volatile anesthetics and opioids during perioperative periods were suggested to be implicated in immunosuppression and cancer recurrence [7]. The underlying mechanism remains elusive, which was mainly attributed to improve immunosuppression via attenuating surgical stress and postoperative pain, reducing requirements for opioid and anesthetics, and direct anti-metastasis effects of local anesthetics [58]. The results found that, compared with general anesthesia alone with postoperative intravenous analgesia, combined epidural-general anesthesia with postoperative epidural analgesia did not improve overall or cancer-specific mortality, or the recurrence-free survival after a median follow-up duration of 66 months [96] Another retrospective study did not support an association

Study design

Findings

CONCLUSION