title: A retrospective analysis of the effect of intraoperative opioid dose on cancer recurrence after non-small cell lung cancer resection.
abstract: Preclinical studies have demonstrated that opioid receptor agonists increase the rate of non-small cell lung cancer (NSCLC) growth and metastasis. Following institutional review board approval, we retrieved data on 901 patients who underwent surgery for NSCLC at MD Anderson Cancer Center. Comprehensive demographics, intraoperative data, and recurrence-free survival (RFS) and overall survival (OS) at 3 and 5 years were obtained. Cox proportional analyses were conducted to assess the association between intraoperative opioid exposure and RFS and OS. The median intraoperative fentanyl equivalents dosage was 10.15 μg/kg. The multivariate analysis by stage indicated that a trend toward significance for opioid consumption as a risk factor in stage I patients (P = 0.053). No effect was found on RFS for stage II or III patients. Alternatively, opioid consumption was a risk factor for OS for stage I patients (P = 0.036), whereas no effect was noted for stage II or III patients. Intraoperative opioid use is associated with decreased OS in stage I but not stage II-III NSCLC patients. Until randomized controlled studies explore this association further, opioids should continue to be a key component of balanced anesthesia.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, Texas.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
authors.forename: Visesh
authors.initials: V
authors.lastname: Keerty
authors.forename: Dinesh
authors.initials: D
authors.lastname: Keerty
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.forename: Peter H
authors.initials: PH
authors.lastname: Norman
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
authors.forename: John R
authors.initials: JR
authors.lastname: Mehran
authors.forename: Mitchel
authors.initials: M
authors.lastname: Engle
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl
keywords: Neoplasms; opioids; recurrence; surgery