title: The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma.
abstract: BACKGROUND
  Retrospective studies report that the benefit of regional anesthesia on cancer recurrence may depend on the specific tumor type. We compared the association between anesthetic technique and cancer recurrence in patients undergoing percutaneous radiofrequency ablation (RFA) of small hepatocellular carcinoma (HCC).
  
  
  METHODS
  We retrospectively reviewed medical records of patients with small HCC treated with RFA between August 1999 and December 2008. Patients receiving epidural anesthesia were compared with a group given general anesthesia. The end points were recurrence-free survival and overall survival, which 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
  The hazard ratio for recurrence-free survival in the epidural anesthesia group compared with the general anesthesia group was 3.66 (95% confidence interval [CI], 2.59-5.15; P < 0.001) in the Cox regression model and 4.31 (95% CI, 2.24-8.29; P < 0.001) in the analysis adjusted for propensity score with inverse probability weights. The hazard ratio for overall survival in the epidural anesthesia group compared with the general anesthesia group was 0.77 (95% CI, 0.50-1.18; P = 0.232) in the Cox regression model and 1.26 (95% CI, 0.81-1.97; P = 0.312) in the analysis adjusted for propensity score with inverse probability weights.
  
  
  CONCLUSIONS
  This retrospective analysis suggests that treatment of small HCC by RFA under general anesthesia is associated with reduced risk of cancer recurrence. No effect of anesthetic technique on overall survival is detected. Prospective, randomized trials to evaluate this association are warranted.
authors: Department of Hepatobiliary Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors: Renchun
authors: R
authors: Lai
authors: Zhenwei
authors: Z
authors: Peng
authors: Dongtai
authors: D
authors: Chen
authors: Xudong
authors: X
authors: Wang
authors: Wei
authors: W
authors: Xing
authors: Weian
authors: W
authors: Zeng
authors: Minshan
authors: M
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden