The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival.
This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated.
The median disease-free survival of the patients who received combined anesthesia was 585 (240-1,005) days versus 210 (90-645) days in the other group. A significant difference was observed between the two groups (p = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315-1,545] disease-free days) and those who received sevoflurane and opioids (150 [90-450] disease-free days) (p = 0.02).
Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.
Oncology. 2020 Jan 21 [Epub ahead of print]
Jose Luis Guerrero Orriach, Aida Raigon Ponferrada, Alfredo Malo Manso, Bernardo Herrera Imbroda, Juan Jose Escalona Belmonte, Marta Ramirez Aliaga, Alicia Ramirez Fernandez, Julia Diaz Crespo, Angela M Soriano Perez, Ana Fontaneda Heredia, Maria Emilia Dominguez Recio, Manuel Rubio Navarro, Jose Cruz Mañas
Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain, ., Department of Anesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain., Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain., Department of Anesthesiology, Complejo Hospitalario de Jaén, Jaén, Spain., Department of Oncology, Virgen de la Victoria University Hospital, Malaga, Spain.