title: Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer?
abstract: BACKGROUND
  The potential impact of intraoperative analgesics on oncological outcome after radical prostatectomy is debated. Some investigators have suggested that use of opioids favour relapse, whereas regional analgesia and NSAIDs improve oncological outcomes.
  
  
  OBJECTIVE
  To evaluate the impact of intraoperative analgesia (epidural and intravenous) on the incidence of biochemical recurrence-free (BRF) survival.
  
  
  METHODS
  This retrospective study includes 1111 consecutive retropubic radical prostatectomies (RRPs) for localised prostate cancer, performed between 1993 and 2006. Median follow-up was 38 months (interquartile range 16-69). BRF survival probabilities were compared with log-rank tests and the Cox regression model.
  
  
  RESULTS
  Epidural analgesia was used in 52% of patients, intravenous ketorolac in 25%, sufentanil in 97%, clonidine in 25% and ketamine in 16%. Univariate and multivariate analyses showed that intravenous sufentanil significantly reduced BRF survival rate, hazard ratio 7.78 [95% confidence interval (CI) 5.79, 9.78), for extracapsular extension stage pT 2 or less, hazard ratio 0.44 (95% CI 0.12, 0.75), Gleason score at least 7, hazard ratio 1.96 (95% CI 1.65, 2.26), positive margin, hazard ratio 1.87 (95% CI 1.58, 2.02) and lymph node involvement, hazard ratio 1.77 (95% CI 1.27, 2.27, P > 0.05). In contrast, neither epidural analgesia nor other analgesics were associated with a statistically significant effect (P > 0.05).
  
  
  CONCLUSIONS
  This retrospective analysis suggests that intraoperative sufentanil administration is associated with an increased risk of cancer relapse after RRP, whereas epidural analgesia, with local anaesthetic and opioid, was not associated with a significant effect.
authors.affiliation: Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. forgetpatrice@yahoo.fr
authors.forename: Patrice
authors.initials: P
authors.lastname: Forget
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tombal
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Scholtès
authors.forename: Jolio
authors.initials: J
authors.lastname: Nzimbala
authors.forename: Catherine
authors.initials: C
authors.lastname: Meulders
authors.forename: Catherine
authors.initials: C
authors.lastname: Legrand
authors.forename: Paul
authors.initials: P
authors.lastname: Van Cangh
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cosyns
authors.forename: Marc
authors.initials: M
authors.lastname: De Kock
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics