Association between neuraxial analgesia, cancer progression, and mortality after radical prostatectomy: a large, retrospective matched cohort study

British Journal of Anaesthesia
F ScavonettoJ Sprung

Abstract

Systemic opioids are immunosuppressive, which could promote tumour recurrence. We, therefore, test the hypothesis that supplementing general anaesthesia with neuraxial analgesia improves long-term oncological outcomes in patients having radical prostatectomy for adenocarcinoma. Patients who had general anaesthesia with neuraxial analgesia (n=1642) were matched 1:1 based on age, surgical year, pathological stage, Gleason scores, and presence of lymph node disease with those who had general anaesthesia only. Medical records were reviewed. Outcomes of interest were systemic cancer progression, recurrence, prostate cancer mortality, and all-cause mortality. Data were analysed using stratified proportional hazards regression, the Kaplan-Meier method, and log-rank tests. The median follow-up was 9 yr. After adjusting for comorbidities, positive surgical margins, and adjuvant hormonal and radiation therapies within 90 postoperative days, general anaesthesia only was associated with increased risk for systemic progression [hazard ratio (HR)=2.81, 95% confidence interval (CI) 1.31-6.05; P=0.008] and higher overall mortality (HR=1.32, 95% CI 1.00-1.74; P=0.047). Although not statistically significant, similar findings were observed for t...Continue Reading

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Citations

Aug 22, 2014·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Behfar EhdaieDavid Amar
Jul 24, 2014·British Journal of Anaesthesia·D J Buggy, H C Hemmings
Feb 7, 2016·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Toby N WeingartenJuraj Sprung
Oct 27, 2015·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Kathryn ByrneDonal J Buggy
Sep 9, 2015·Journal of Clinical Anesthesia·Dermot P Maher, Paul F White
Nov 2, 2014·International Journal of Cancer. Journal International Du Cancer·Wei XuanDaqing Ma
Mar 19, 2015·Frontiers in Oncology·Alexandru Dan GrigoreMary C Farach-Carson
Dec 17, 2014·British Journal of Anaesthesia·A S Chana, R P Mahajan
Nov 10, 2016·Anesthesia and Analgesia·Mir W SekandarzadMarkus W Hollmann
Jul 19, 2018·Current Opinion in Anaesthesiology·Juan P Cata
Jan 23, 2016·Anesthesia and Analgesia·José A AguirreMichael Zaugg
May 31, 2019·Current Opinion in Anaesthesiology·Junichi SaitoDaqing Ma
Jul 13, 2017·Current Opinion in Anaesthesiology·Mir W SekandarzadMarkus W Hollmann
Jun 4, 2016·Current Opinion in Anaesthesiology·Thomas PoyserAndrew Smith
Mar 19, 2016·Current Opinion in Supportive and Palliative Care·Timothy Wigmore, Paul Farquhar-Smith
Sep 19, 2019·Urologic Oncology·Avril J LustyD Robert Siemens
May 4, 2021·Current Opinion in Anaesthesiology·Julia DubowitzBernhard Riedel
Aug 7, 2021·International Journal of Clinical Oncology·Yuto BabaMototsugu Oya

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