title: Epidural anesthesia and cancer recurrence rates after radical prostatectomy.
abstract: OBJECTIVE
  To determine the effect of adjunctive epidural local anesthetic and opioid infusion on disease recurrence following radical prostatectomy for adenocarcinoma under general anesthesia.
  
  
  METHODS
  This article describes a secondary analysis of subjects undergoing radical prostatectomy who had participated previously in a randomized controlled trial evaluating pain control, blood loss, and the need for perioperative allogeneic blood transfusion. The patients were randomly allocated to receive either general anesthesia alone (control group; n = 50) or combined general/epidural anesthesia (study group; n = 49). A long-term follow-up chart review was undertaken to determine clinically evident or biochemical (Prostate Specific Antigen > 0.2 ng x mL(-1)) recurrence of prostate cancer. Comparison by group was undertaken using survival analysis.
  
  
  RESULTS
  Median disease-free survival for the study as a whole was 1644 days, and the longest recorded survival was 3403 days. Biochemical recurrence of prostate cancer was observed in 11/49 study subjects and 17/50 control subjects. There was one death from prostate cancer in each group and a total of five deaths in the study group and six deaths in the control group. The hazard ratio for recurrence in the study group compared with the control group was 1.33 (95% confidence intervals 0.64-2.77; P = 0.44 by log-rank test).
  
  
  CONCLUSIONS
  No difference was observed between the epidural and control groups in disease-free survival at a median follow-up time of 4.5 years. There is a need for large randomized controlled trials to determine the ability of epidural analgesia to alter disease recurrence rates following radical prostatectomy.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada. btsui@ualberta.ca
authors.forename: Ban C H
authors.initials: BC
authors.lastname: Tsui
authors.forename: Saifudin
authors.initials: S
authors.lastname: Rashiq
authors.forename: Donald
authors.initials: D
authors.lastname: Schopflocher
authors.forename: Albert
authors.initials: A
authors.lastname: Murtha
authors.forename: Sunita
authors.initials: S
authors.lastname: Broemling
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pillay
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Finucane
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local