scholarly journals Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

2021 ◽  
Author(s):  
Zhen-Zhen Xu ◽  
Huai-Jin Li ◽  
Mu-Han Li ◽  
Si-Ming Huang ◽  
Xue Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
General Anesthesia ◽  
Survival Time ◽  
Epidural Anesthesia ◽  
Lung Cancer Surgery ◽  
Hazard Ratio ◽  
Cancer Surgery ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

Background Regional anesthesia and analgesia reduce the stress response to surgery and decrease the need for volatile anesthesia and opioids, thereby preserving cancer-specific immune defenses. This study therefore tested the primary hypothesis that combining epidural anesthesia–analgesia with general anesthesia improves recurrence-free survival after lung cancer surgery. Methods Adults scheduled for video-assisted thoracoscopic lung cancer resections were randomized 1:1 to general anesthesia and intravenous opioid analgesia or combined epidural–general anesthesia and epidural analgesia. The primary outcome was recurrence-free survival (time from surgery to the earliest date of recurrence/metastasis or all-cause death). Secondary outcomes included overall survival (time from surgery to all-cause death) and cancer-specific survival (time from surgery to cancer-specific death). Long-term outcome assessors were blinded to treatment. Results Between May 2015 and November 2017, 400 patients were enrolled and randomized to general anesthesia alone (n = 200) or combined epidural–general anesthesia (n = 200). All were included in the analysis. The median follow-up duration was 32 months (interquartile range, 24 to 48). Recurrence-free survival was similar in each group, with 54 events (27%) with general anesthesia alone versus 48 events (24%) with combined epidural–general anesthesia (adjusted hazard ratio, 0.90; 95% CI, 0.60 to 1.35; P = 0.608). Overall survival was also similar with 25 events (13%) versus 31 (16%; adjusted hazard ratio, 1.12; 95% CI, 0.64 to 1.96; P = 0.697). There was also no significant difference in cancer-specific survival with 24 events (12%) versus 29 (15%; adjusted hazard ratio, 1.08; 95% CI, 0.61 to 1.91; P = 0.802). Patients assigned to combined epidural–general had more intraoperative hypotension: 94 patients (47%) versus 121 (61%; relative risk, 1.29; 95% CI, 1.07 to 1.55; P = 0.007). Conclusions Epidural anesthesia–analgesia for major lung cancer surgery did not improve recurrence-free, overall, or cancer-specific survival compared with general anesthesia alone, although the CI included both substantial benefit and harm. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Perioperative epidural analgesia and recurrence-free survival for ovarian cancer surgery: A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16534-e16534
Author(s):  
Dominique Koensgen ◽  
Alexander Mustea ◽  
Barbara Rosanowski ◽  
Bianca Leutzow ◽  
Thomas Hesse ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Opioid Analgesia ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Group A ◽  
Group B

e16534 Background: Current experimental and clinical data suggest that perioperative factors may influence the long-term outcome after cancer surgery. Recent retrospective analyses have shown the reduction of cancer recurrence and metastatic spread in patients after tumor surgery receiving perioperative regional and neuraxial analgesia. The aim was to investigate whether perioperative epidural anesthesia is associated with the decreased disease recurrence and increased survival after primary tumor debulking in patients with ovarian cancer. Methods: Retrospective analysis of consecutive patients with primary ovarian cancer who underwent radical multivisceral surgery between 01/2003 and 12/2010 under either general anesthesia plus opioid analgesia (group A) or general anesthesia plus epidural anesthesia (group B), was performed. Cancer recurrence-free survival and total survival times after surgery were compared between the groups using Mann-Whitney test. The analysis was strengthened by Kaplan-Meier survival estimates for each group with comparison using the log-rank test. Results: Data of 105 (88%) of patients (group A: 33; group B: 72) were available for analysis. The median (interquartile range-IQR) follow-up time 27 (17-58) months. The groups were comparable regarding age, body-mass index, ASA physiological status, FIGO staging, tumor residual and use of adjuvant platinum-based chemotherapy. The median (IQR) time to recurrence of cancer was 31 (15-63) months in group A vs. 18 (10-35) months in group B (p = 0.017). Longer recurrence-free survival was associated with general anesthesia and opioid analgesia (hazard ratio 1.52; 95% confidence interval 1.4-1.56; p = 0.008). Conclusions: In contrast to previous investigations, perioperative epidural anesthesia was associated with decreased survival in patients after ovarian cancer surgery.

scholarly journals The prognostic impact of obstructive lung disease on survival of never smokers with resected non-small-cell lung cancer: a comparison with smokers

2019 ◽  
Vol 28 (5) ◽  
pp. 735-743
Author(s):  
Takaki Akamine ◽  
Tetsuzo Tagawa ◽  
Mototsugu Shimokawa ◽  
Taichi Matsubara ◽  
Yuka Kozuma ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Small Cell ◽  
Recurrence Free Survival ◽  
Small Cell Lung ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Never Smokers ◽  
Nsclc Patients

Abstract OBJECTIVES The proportion of never smokers among non-small-cell lung cancer (NSCLC) patients has steadily increased in recent decades, suggesting an urgent need to identify the major underlying causes of disease in this cohort. Chronic obstructive pulmonary disease is a risk factor for lung cancer in both smokers and never smokers. The aim of this study was to investigate the association between obstructive lung disease and survival in never smokers and smokers with NSCLC after complete resection. METHODS We retrospectively reviewed data from 548 NSCLC patients treated at our institution. The effects of obstructive lung disease on recurrence-free survival and cancer-specific survival following the resection of NSCLC were determined by univariable and multivariable Cox regression analyses. RESULTS Among the 548 patients analysed, 244 patients (44.5%) were never smokers and 304 patients (55.4%) were current or former smokers. In the never-smoker group, 48 patients (19.7%) had obstructive lung disease, 185 patients (75.8%) were women and 226 patients (92.6%) had adenocarcinoma. Obstructive lung disease was significantly associated with shorter recurrence-free survival (P = 0.006) and cancer-specific survival (P = 0.022) in the never smokers, but not the smokers, on both univariable and multivariable analyses. The associations between obstructive lung disease and prognosis in never smokers remained significant after propensity score matching. CONCLUSIONS Obstructive lung disease is an independent prognostic factor for recurrence-free survival and cancer-specific survival in never smokers, but not in smokers, with NSCLC. Based on this finding, further examination is warranted to advance our understanding of the mechanisms associated with NSCLC in never smokers.

Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy

2018 ◽  
Vol 36 (23) ◽  
pp. 2378-2385 ◽  
Author(s):  
Daniel J. Boffa ◽  
Andrzej S. Kosinski ◽  
Anthony P. Furnary ◽  
Sunghee Kim ◽  
Mark W. Onaitis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Lung Cancer Surgery ◽  
Hazard Ratio ◽  
Cancer Surgery ◽  
Stage I ◽  
Invasive Approach ◽  
Longitudinal Outcome ◽  
Stage I Lung Cancer

Purpose The prevalence of minimally invasive lung cancer surgery using video-assisted thoracic surgery (VATS) has increased dramatically over the past decade, yet recent studies have suggested that the lymph node evaluation during VATS lobectomy is inadequate. We hypothesized that the minimally invasive approach to lobectomy for stage I lung cancer resulted in a longitudinal outcome that was not inferior to thoracotomy. Patients and Methods Patients > 65 years of age who had undergone lobectomy for stage I lung cancer between 2002 and 2013 were analyzed within the Society of Thoracic Surgeons General Thoracic Surgery Database, which had been linked to Medicare data, as part of a retrospective-cohort, noninferiority study. Results A total of 10,597 patients with clinical stage I lung cancer who underwent lobectomy were evaluated (4,448 patients underwent thoracotomy, and 6,149 underwent VATS). VATS patients had a more favorable distribution of all health-related variables, including pulmonary function (59% of VATS patients had intact spirometry v 51% of thoracotomy patients; P < .001). Cox proportional hazards models were performed over two eras to account for an evolving practice standard. The mortality risk associated with the VATS approach was not greater than thoracotomy in either the earlier era (2002 to 2008; hazard ratio, 0.97; 95% CI, 0.87 to 1.09; P = .62) or the more recent era (2009 to 2013; hazard ratio, 0.84; 95% CI, 0.75 to 0.93; P < .001). Kaplan-Meier survival estimates of 2,901 propensity-matched VATS-thoracotomy pairs demonstrated that the 4-year survival associated with VATS (68.6%) was modestly superior to thoracotomy (64.8%; P = .003). The analyses detailed above were replicated in a separate cohort of pathologic stage I patients with similar findings. Conclusion The long-term efficacy of lobectomy for stage I lung cancer performed using the VATS approach by board-certified thoracic surgeons does not seem to be inferior to that of thoracotomy.

scholarly journals Potential Influence of the Anesthetic Technique Used during Open Radical Prostatectomy on Prostate Cancer-related Outcome

2010 ◽  
Vol 113 (3) ◽  
pp. 570-576 ◽  
Author(s):  
Patrick Y. Wuethrich ◽  
Shu-Fang Hsu Schmitz ◽  
Thomas M. Kessler ◽  
George N. Thalmann ◽  
Urs E. Studer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Biochemical Recurrence ◽  
Progression Free Survival ◽  
Anesthetic Technique ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Thoracic Epidural

Background Recently published studies suggest that the anesthetic technique used during oncologic surgery affects cancer recurrence. To evaluate the effect of anesthetic technique on disease progression and long-term survival, we compared patients receiving general anesthesia plus intraoperative and postoperative thoracic epidural analgesia with patients receiving general anesthesia alone undergoing open retropubic radical prostatectomy with extended pelvic lymph node dissection. Methods Two sequential series were studied. Patients receiving general anesthesia combined with epidural analgesia (January 1994-June 1997, n=103) were retrospectively compared with a group given general anesthesia combined with ketorolac-morphine analgesia (July 1997-December 2000, n=158). Biochemical recurrence-free survival, clinical progression-free survival, cancer-specific survival, and overall survival were assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional-hazards regression model and an alternative model with inverse probability weights to adjust for propensity score. Results Using propensity score adjustment with inverse probability weights, general anesthesia combined with epidural analgesia resulted in improved clinical progression-free survival (hazard ratio, 0.45; 95% confidence interval, 0.27-0.75, P=0.002). No significant differences in the two groups were found for biochemical recurrence-free survival, cancer-specific survival, or overall survival. Higher preoperative serum values for prostate-specific antigen, specimen Gleason score of at least 7, non-organ-confined tumor stage, and positive lymph node status were independent predictors of biochemical recurrence-free survival. Conclusions General anesthesia with epidural analgesia was associated with a reduced risk of clinical cancer progression. However, no significant difference was found between general anesthesia plus postoperative ketorolac-morphine analgesia and general anesthesia plus intraoperative and postoperative thoracic epidural analgesia in biochemical recurrence-free survival, cancer-specific survival, or overall survival.

scholarly journals Volatile versus Total Intravenous Anesthesia for Cancer Prognosis in Patients Having Digestive Cancer Surgery

2020 ◽  
Vol 133 (4) ◽  
pp. 764-773 ◽  
Author(s):  
Kanako Makito ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Hazard Ratio ◽  
Cancer Surgery ◽  
Cancer Prognosis ◽  
Total Intravenous Anesthesia ◽  
Recurrence Free Survival ◽  
Intravenous Anesthesia ◽  
Free Survival ◽  
Anesthesia Group ◽  
Volatile Anesthesia ◽  
Type Of Surgery

Background Previous experimental and clinical studies have shown that anesthetic agents have varying effects on cancer prognosis; however, the results were inconsistent among these studies. The authors compared overall and recurrence-free survival in patients given volatile or intravenous anesthesia for digestive tract cancer surgery. Methods The authors selected patients who had elective esophagectomy, gastrectomy, hepatectomy, cholecystectomy, pancreatectomy, colectomy, and rectal cancer surgery from July 2010 to March 2018 using the Japanese Diagnosis Procedure Combination database. Patients were divided into a volatile anesthesia group (desflurane, sevoflurane, or isoflurane with/without nitrous oxide) and a propofol-based total intravenous anesthesia group. The authors hypothesized that total intravenous anesthesia is associated with greater overall and recurrence-free survival than volatile anesthesia. Subgroup analyses were performed for each type of surgery. Results The authors identified 196,303 eligible patients (166,966 patients in the volatile anesthesia group and 29,337 patients in the propofol-based total intravenous anesthesia group). The numbers (proportions) of death in the volatile anesthesia and total intravenous anesthesia groups were 17,319 (10.4%) and 3,339 (11.4%), respectively. There were no significant differences between the two groups in overall survival (hazard ratio, 1.02; 95% CI, 0.98 to 1.07; P = 0.28) or recurrence-free survival (hazard ratio, 0.99; 95% CI, 0.96 to 1.03; P = 0.59), whereas instrumental variable analyses showed a slight difference in recurrence-free survival (hazard ratio, 0.92; 95% CI, 0.87 to 0.98; P = 0.01). Subgroup analyses showed no significant difference in overall or recurrence-free survival between the groups in any type of surgery. Conclusions Overall and recurrence-free survival were similar between volatile and intravenous anesthesia in patients having digestive tract surgery. Selection of the anesthetic approach for these patients should be based on other factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Does Vein-first Lobectomy Control Postoperative Circulating Tumor Cells in Lung Cancer?: a Retrospective Observational Study

2021 ◽  
Author(s):  
Noriyoshi Sawabata ◽  
Shigeru Nakane ◽  
Daiki Yoshikawa ◽  
Takashi Watanabe ◽  
Takeshi Kawaguchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tumor Cell ◽  
Survival Rates ◽  
Lung Cancer Surgery ◽  
Circulating Tumor Cell ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
The Status ◽  
Cell Testing ◽  
Overall Survival Rates

Abstract Background: Vein-first dissecting lobectomy in lung cancer surgery is speculated to limit the amount of circulating tumor cells. We aimed to assess the clinical significance and prognostic impact of Vein-first dissecting lobectomy according to changes in circulating tumor cell status throughout the perioperative period.Methods: Among patients with pulmonary nodule who underwent surgery, we extracted and evaluated patients who underwent lobectomy for lung cancer and had underwent circulating tumor cell testing before and immediately after the completion of lobectomy. The primary evaluation item was the detection rate of postoperative circulating tumor cell according to the sequence of pulmonary vessel processing. The secondary evaluation items were the 2-year recurrence-free survival and overall survival rates according to the status of Vein-first dissecting lobectomy and postoperative circulating tumor cell. Results: Between June 2014 and June 2018, 302 patients with pulmonary nodule underwent surgery, among them we selected 86 patients who underwent lobectomy for lung cancer and had circulating tumor cell testing done before and immediately after the completion of lobectomy. The circulating tumor cell identification rates in the postoperative period were 54.4% (37/68) and 66.7% (12/18) (p=0.8) in vein-first dissecting lobectomy group and no-vein-first dissecting lobectomy group, respectively. The mean postoperative circulating tumor cell count was not significantly different between the vein-first dissecting lobectomy and no-vein-first dissecting lobectomy groups (3.0 ± 3.6 vs 3.2 ± 5.0, p=0.8). The 2-year recurrence-free survival and overall survival rates were also not significantly different. However, the presence of circulating tumor cell after surgery was a predictor of recurrence.Conclusions: Although the detection of circulating tumor cell after surgery is a predictor of cancer recurrence, no significant difference was observed in the status of postoperative circulating tumor cell s between vein-first dissecting lobectomy and no- vein-first dissecting lobectomy groups in lung cancer surgery.

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