Analysis of the effects of drugs and techniques used in anesthesia on tumour recurrence, metastasis and survival in ovarian serous adenocarcinoma
Keywords:Anaesthetic technique, Survival rate, Ovarian serous adenocarcinoma
Background: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anaesthetic techniques have effects on tumour recurrence.
Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingoopherectomy from 1995-2008 were analysed for the effect of anaesthetic techniques and drugs on tumour recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anaesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors.
Results: The overall survival rate (RR at 95% CI=3.16(1.79-5.60) was significantly better in patients who received regional anaesthesia for surgery than those who had general anaesthesia. Other factors significantly associated with overall survival rate in univariable analysis were,perioperative blood transfusion,preoperative Ca 125 level, FIGO stage, tumour size and lymphatic metastasis.Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate.Recurrence rate did not show significant difference in univariable(Odds 95% CI 1.42 P = 0.273)and multivariable(Odds 95% CI = 0 P = 0.846) analysis.Al1the 18 patients who had metastasis underwent surgery under GA.
Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anaesthesia when compared to those who had surgery under general anaesthesia. Prospective randomized control trials are needed for better evaluation.
Gottschalk A, Brodner G, Van AHK, Elger B, Althaus S, Schulze HJ. Can regional anaesthesia for lymph node dissection improve the prognosis in malignant melanoma? British Journal of Anaesthesia. 2012; 109(2):253-9.
Gottschalk A, Sharma S, Ford J, Durieux ME, Tiouririne M. Review article: The role of perioperative period in recurrence after cancer surgery.Anesth Analg. 2010;17(Supp.1):S27-36
Melamed R, Rosenne E, Shakhar K, Schwartz Y, Abudarham N, Ben ES. Marginating pulmonary-NK activity and resistance to experimental tumor metastasis: suppression by surgery and the prophylactic use of a beta-adrenergic antagonist and a prostaglandin synthesis inhibitor. Brain Behav Immun. 2005;19:114-26.
Ben ES. The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain Behav Immun. 2003;17(Suppl. 1):S27-36.
Smyth MJ, Godfrey DI, Trapani JA. A fresh look at tumor immunosurveillance and immunotherapy. Nat Immunol. 2001;2:293-9.
Bonnet F, Marret E. Influence of anesthetic and analgesic techniques on outcome after surgery. Br J Anaesth. 2005;95:52-8.
Melamed R, Bar-Yosef S, Shakhar G, Shakhar K, Ben-Eliyahu S. Suppression of natural killer cell activity and promotion of tumor metastasis by ketamine, thiopental, and halothane, but not by propofol: mediating mechanisms and prophylactic measures. Anesth Analg. 2003;97:1331-9.
Markovic SN, Knight PR, Murasko DM. Inhibition of interferon stimulation of natural killer cell activity in mice anesthetized with halothane or isoflurane.Anesthesiology. 1993;78:700-6.
Erskine R, Janicki PK, Ellis P, James MF. Neutrophils from patients undergoing hip surgery exhibit enhanced movement under spinal anesthesia compared with general anesthesia. Can J Anaesth. 1992;39:905-10.
Loop T, Scheiermann P, Doviakue D, Musshoff F, Humar M, Roesslein M, et al. Sevoflurane inhibits phorbol-myristate-acetate-induced activator protein-1 activation in human T lymphocytes in vitro: potential role of the p38-stress kinase pathway. Anesthesiology. 2004;101:710-21.
O'Riain SC, Buggy DJ, Kerin MJ, Watson RW, Moriarty DC. Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg. 2005;100:244-9.
Beilin B, Shavit Y, Trabekin E, Mordashev B, Mayburd E, Zeidel, et al. The effects of postoperative pain management on immune response to surgery. Anesth Analg. 2003;97:822-7.
Wada H, Seki S, Takahashi T, Kawarabayashi N, Higuchi H, Habu Y, et al. Combined spinal and general anesthesia attenuates liver metastasis by preserving TH1/TH2 cytokine balance. Anesthesiology 2007;106(3):499-506.
Bar YS, Melamed R, Page GG, Shakhar G, Shakhar K, Ben ES. Attenuation of the tumor-promoting effect of surgery by spinal blockade in rats. Anesthesiology. 2001;94:1066-73.
Moller JF, Nikolajsen L, Rodt SA, Ronning H, Carisson PS. Thoracic paravertebral block for breast cancer surgery: a randomised double blind study.Anesth Analg. 2007;105:1848-51.
Yoon JR, Whipple RA, Bazer EM, Cho EH, Ma-trone MA, Peckham M, et al. Local anaesthetics inhibit kinesin motility and micro tentacle protrusions in human epithelial and breast tumour cels. Breast Cancer Res Treat. 2011;129:691-701.
Brackenbury WJ. Voltage gated sodium channels and metastatic disease. Channels (Aus-tin). 2012;6:5.
Fraser SP, Diss JK, Chioni AM, Mycielska ME, Pan H, Yamaci RF, et al. Voltage gated sodium channel expression and potentiation of human breast cancer metastasis. Clin Cancer Res. 2005;11:5381-9.
House CD, Vaske CJ, Schwartz AM, Obias V, Frank B, Luu T, et al .Voltage gated Na + channel SCN5A is a key regulator of a gene transcriptional network that controls colon cancer invasion. Cancer Res. 2010;70:6957-67.
Roger S, Rollin J, Barascu A, Besson P, Raynal PI,Iochmann S, et al. Voltage gated sodium channels potentiate the invasive capacities of human non small cell lung cancer cell lines.int J Biochem Cell Bio. 2007;39:774-86.
Yidirim S, Altun S, Gumushan H, Pate A and Djamgoz MB. Voltage gated sodium channel activity promotes prostate cancer metastasis in vivo. Cancer Lett. 2012;323:58-61.
Roger S, Rollin J, Barascu A, Besson P, Raynal PI, Iochmann S, et al. Voltage gated sodium channels potentiates the invasive capacities of human non small cell lung cancer cell lines. Int J Biochem Cell Biol. 2007;39:774-86.
Yidrim S, Altun S, Gumushan H, Patel A, Djamgoz MB. Voltage gated sodium channel activity promotes prostatate cancer metastasis in vivo. Cancer Lett. 2012;323:58-61.