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PERIOPERATIVE MEDICINE
Copyright 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins Potential Influence of the Anesthetic Technique Used
during Open Radical Prostatectomy on Prostate
Cancer-related Outcome

Patrick Y. Wuethrich, M.D.,* Shu-Fang Hsu Schmitz, Ph.D.,† Thomas M. Kessler, M.D.,‡George N. Thalmann, M.D.,§ Urs E. Studer, M.D.,ʈ Frank Stueber, M.D.,# Fiona C. Burkhard, M.D.ʈ ABSTRACT
survival (hazard ratio, 0.45; 95% confidence interval, 0.27– Background: Recently published studies suggest that the
0.75, P ϭ 0.002). No significant differences in the two anesthetic technique used during oncologic surgery affects groups were found for biochemical recurrence-free survival, cancer recurrence. To evaluate the effect of anesthetic tech- cancer-specific survival, or overall survival. Higher preoper- nique on disease progression and long-term survival, we ative serum values for prostate-specific antigen, specimen compared patients receiving general anesthesia plus intraop- Gleason score of at least 7, non– organ-confined tumor stage, erative and postoperative thoracic epidural analgesia with and positive lymph node status were independent predictors patients receiving general anesthesia alone undergoing open of biochemical recurrence-free survival.
retropubic radical prostatectomy with extended pelvic lymph Conclusions: General anesthesia with epidural analgesia was
associated with a reduced risk of clinical cancer progression.
Methods: Two sequential series were studied. Patients re-
However, no significant difference was found between general ceiving general anesthesia combined with epidural analgesia anesthesia plus postoperative ketorolac-morphine analgesia and (January 1994 –June 1997, n ϭ 103) were retrospectively general anesthesia plus intraoperative and postoperative thoracic compared with a group given general anesthesia combined epidural analgesia in biochemical recurrence-free survival, can- with ketorolac-morphine analgesia (July 1997–December cer-specific survival, or overall survival.
2000, n ϭ 158). Biochemical recurrence-free survival, clin-ical progression-free survival, cancer-specific survival, andoverall survival were assessed using the Kaplan–Meier tech- What We Already Know about This Topic
nique and compared using a multivariate Cox-proportional- ❖ Whether intraoperative anesthetic management affects can- hazards regression model and an alternative model with in- cer progression after cancer surgery is unclear verse probability weights to adjust for propensity score.
Results: Using propensity score adjustment with inverse
What This Article Tells Us That Is New
probability weights, general anesthesia combined with epi- ❖ In a nonrandomized, retrospective review of more than 250 dural analgesia resulted in improved clinical progression-free patients having retropubic prostatic resection for cancer,there was no difference in biochemical recurrence-free sur-vival, overall survival, or cancer-specific survival in a compar-ison of general anesthesia and general anesthesia plus epi- * Consultant, # Chairman and Professor, University Department of dural anesthesia/analgesia, although the risk of clinical cancer Anaesthesiology and Pain Therapy, § Chairman and Professor, progression was reduced with the latter combined technique ‡ Consultant, ʈ Professor, Department of Urology, University Hospi-tal Bern, Berne, Switzerland. † Biostatistician, Institute of Mathemat-ical Statistics and Actuarial Science, University of Bern.
Received from the Department of Anesthesiology and Pain Therapy, University Hospital Bern, Berne, Switzerland. Submitted for publication RECENTLY published studies suggest that the anes-
thetic technique performed during oncologic surgery July 7, 2009. Accepted for publication April 14, 2010. Support was affects disease recurrence.1,2 Among the possible reasons for provided solely from institutional and/or departmental sources.
this effect are the influence of the anesthetic technique itself Address reprint requests to Dr. Wuethrich: University Depart- or the effect of the specific anesthetic drug on host and tumor ment of Anaesthesiology and Pain Therapy, Inselspital, Freiburgstrasse,CH-3010 Berne, Switzerland. patrick.wuethrich@insel.ch. Individual ar- cell biology. Combined regional and general anesthesia has ticle reprints may be purchased through the Journal Web site, been reported to decrease the recurrence rate after surgery www.anesthesiology.org or on the masthead page at the beginning of for breast cancer (paravertebral block)2 and prostate can- this issue. ANESTHESIOLOGY articles are made freely accessible to allreaders, for personal use only, 6 months from the cover date of the issue.
cer (thoracic epidural analgesia),1 but no data have been Anesthesiology, V 113 • No 3 • September 2010

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