Impact of epidural anesthesia on prostate cancer recurrence remains unclear
MedWire News: There is no significant difference in mean disease-free survival between men undergoing radical prostatectomy (RP) with general anesthesia, and men given combined general/epidural anesthesia, study results show.
Despite a “clinically appealing and biologically plausible” use for regional anesthesia during cancer surgery to reduce the risk for disease recurrence, the Canadian research team believe a large randomized controlled trial would be necessary to show the benefit.
Led by Ban Tsui (University of Alberta, Edmonton, Canada), the team determined the effect of adjunctive epidural local anesthetic on disease recurrence following RP under general anesthesia using results from a previous randomized controlled trial.
Regional anesthesia has positive effects on the immune system, reducing surgical stress and the need for allogeneic blood transfusion which is known to decrease cancer survival, note the researchers.
They compared 50 men who underwent RP under general anesthesia with 49 who received combined general and epidural anesthesia. The original trial looked at pain control, blood loss, and the need for allogeneic blood transfusions in the two groups.
After a median follow-up of 4.5 years, 11 men in the combined anesthesia and 17 in the general anesthesia group had developed biochemical recurrence, defined as a prostate-specific antigen level exceeding 0.2 ng/ml.
The difference in recurrence rates between the two groups was not statistically significant, the researchers note in the Canadian Journal of Anesthesia. Disease-free survival was in fact nonsignificantly worse in the combined anesthesia group.
One man in each group died from prostate cancer, and a further four and five patients in the combined and general anesthesia groups, respectively, died of other causes.
In an accompanying editorial, Daniel Sessler (Cleveland Clinic, Ohio, USA) said: “The study of Tsui et al is a retrospective analysis of a randomized trial conducted for another purpose, and because it was designed around another endpoint it is seriously underpowered for evaluating cancer recurrence.”
He therefore echoed the investigators’ call for large trials, but suggested that prostate cancer may no longer be the right model to determine the impact of anesthesia on cancer outcome, “since long-term remission rates have improved to such an extent in recent years that a prohibitively large trial would be required.”
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