title: Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: a retrospective analysis.
abstract: BACKGROUND
  Evidence suggests that opioid-sparing anaesthetic techniques might be associated with increased cancer-free postoperative survival. This could be related to suppression of natural killer cells by opioid analgesics in the perioperative period. This retrospective analysis tested the hypothesis that greater opioid use in the postoperative period is associated with a higher incidence of recurrences after surgery for lung cancer.
  
  
  METHODS
  The medical records of 99 consecutive patients who underwent video-assisted thoracoscopic surgery with lobectomy for Stage I or IIa biopsy-proven non-small-cell lung cancer (NSCLC) were reviewed. Perioperative information including patient characteristics, laboratory data, and surgical, anaesthetic, nursing, and pharmacy reports were collected. Doses of opioids administered intra-operatively and for the first 96 h after operation were converted into equianalgesic doses of oral morphine using a standard conversion table. Data were then compared with the National Cancer Registry's incidence of disease-free survival for 5 yr.
  
  
  RESULTS
  A total of 99 patients with similar characteristics were included in the final analysis, 73 of whom were NSCLC recurrence-free at 5 yr and 26 had NSCLC recurrence within 5 yr. Total opioid dose during the 96 h postoperative period was 124 (101) mg of morphine equivalents in the cancer-free group and 232 mg (355) mg in the recurrence group (P=0.02).
  
  
  CONCLUSIONS
  This retrospective analysis suggests an association between increased doses of opioids during the initial 96 h postoperative period with a higher recurrence rate of NSCLC within 5 yr.
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA dermot.maher@cshs.org.
authors.forename: D P
authors.initials: DP
authors.lastname: Maher
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Wong
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy.
authors.forename: P F
authors.initials: PF
authors.lastname: White
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: McKenna
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Rosner
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Shamloo
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Louy
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Wender
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA David Geffen School of Medicine-UCLA, Los Angeles, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Yumul
authors.affiliation: Department of Anaesthesiology, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: V
authors.initials: V
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000188:drug therapy; D011013:Pneumonectomy / Q000379:methods; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D000701:Analgesics, Opioid
keywords: analgesics, opioid; carcinoma, non-small-cell lung; killer cells, natural; pain, postoperative; recurrence