title: Association between neuraxial analgesia, cancer progression, and mortality after radical prostatectomy: a large, retrospective matched cohort study.
abstract: BACKGROUND
  Systemic opioids are immunosuppressive, which could promote tumour recurrence. We, therefore, test the hypothesis that supplementing general anaesthesia with neuraxial analgesia improves long-term oncological outcomes in patients having radical prostatectomy for adenocarcinoma.
  
  
  METHODS
  Patients who had general anaesthesia with neuraxial analgesia (n=1642) were matched 1:1 based on age, surgical year, pathological stage, Gleason scores, and presence of lymph node disease with those who had general anaesthesia only. Medical records were reviewed. Outcomes of interest were systemic cancer progression, recurrence, prostate cancer mortality, and all-cause mortality. Data were analysed using stratified proportional hazards regression, the Kaplan-Meier method, and log-rank tests. The median follow-up was 9 yr.
  
  
  RESULTS
  After adjusting for comorbidities, positive surgical margins, and adjuvant hormonal and radiation therapies within 90 postoperative days, general anaesthesia only was associated with increased risk for systemic progression [hazard ratio (HR)=2.81, 95% confidence interval (CI) 1.31-6.05; P=0.008] and higher overall mortality (HR=1.32, 95% CI 1.00-1.74; P=0.047). Although not statistically significant, similar findings were observed for the outcome of prostate cancer deaths (adjusted HR=2.2, 95% CI 0.88-5.60; P=0.091).
  
  
  CONCLUSIONS
  This large retrospective analysis suggests a possible beneficial effect of regional anaesthetic techniques on oncological outcomes after prostate surgery for cancer; however, these findings need to be confirmed (or refuted) in randomized trials.
authors.affiliation: Department of Anesthesiology.
authors.forename: F
authors.initials: F
authors.lastname: Scavonetto
authors.affiliation: Department of Anesthesiology, Department of Anesthesia, National University Hospital, National University Health System, Singapore, Singapore.
authors.forename: T Y
authors.initials: TY
authors.lastname: Yeoh
authors.affiliation: Department of Urology, and.
authors.forename: E C
authors.initials: EC
authors.lastname: Umbreit
authors.affiliation: Department of Anesthesiology.
authors.forename: T N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Urology, and.
authors.forename: M T
authors.initials: MT
authors.lastname: Gettman
authors.affiliation: Department of Urology, and.
authors.forename: I
authors.initials: I
authors.lastname: Frank
authors.affiliation: Department of Urology, and.
authors.forename: S A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Urology, and.
authors.forename: R J
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Rangel
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Hanson
authors.affiliation: Department of Anesthesiology.
authors.forename: R E
authors.initials: RE
authors.lastname: Hofer
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Department of Anesthesiology, sprung.juraj@mayo.edu.
authors.forename: J
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid
keywords: anaesthesia, general; analgesia, epidural, spinal; cancer progression; neoplasm metastasis; prostatectomy; prostatic neoplasms