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Anestezi Seçiminin Mesane Kanseri Nedeniyle Cerrahiye Giden Hastalarda Sağkalım Üzerine Etkisi: Retrospektif Değerlendirme

Year 2020, Volume: 9 Issue: 1, 1 - 7, 08.04.2020
https://doi.org/10.5505/abantmedj.2020.05902

Abstract

GİRİŞ ve AMAÇ: Rejyonel anestezinin mesane kanseri bulunan hastalarda sağkalım üzerindeki rolünü incelemiş olan çalışma sayısı sınırlıdır. Bu geriye dönük çalışma rejyonel ve genel anestezinin mesane kanseri nedeniyle cerrahi geçiren hastalarda sağkalım üzerine etkilerini karşılaştırmayı amaçlamıştır.

YÖNTEM ve GEREÇLER: Mesane kanseri nedeniyle cerrahi geçiren toplam 181 hasta (ortalama yaş 62±11 yıl, % 82 erkek) bu geriye dönük çalışmaya dahil edilmişlerdir. Hastalara ilişkin tüm veriler hasta dosyalarından alınmıştır. Hastalar rejyonel anestezi (RA grubu, n=120) ve genel anestezi (GA grubu, n=61) olmak üzere iki gruba ayrılmışlardır.

BULGULAR: Rejyonel anestezi uygulanan hastalarda 3 yılllık sağkalım genel anestezi grubuna göre anlamlı olarak yüksekti ( % 96.6’ya karşı % 86.8, p=0.012). Lojistik regresyon analizi postoperatif enfeksiyon gelişiminin (OO: 0.221, % 95 GA: 0.065-0.754, p=0.016) ve rejyonel anestezi uygulamasının (OO: 4.275, % 95 GA: 1.230-14.852, p=0.020) 3 yıllık sağkalım için anlamlı belirleyiciler olduklarını göstermiştir.

TARTIŞMA ve SONUÇ: Bu çalışmanın bulguları mesane kanseri nedeniyle cerrahiye giden hastalarda rejyonel anestezinin genel anesteziye göre daha iyi 3 yıllık sağkalım sağladığını göstermiştir. Postoperatif enfeksiyon gelişimi ve anestezi tekniği sağkalımın önemli belirleyicileri olarak tespit edilmişlerdir.

References

  • Eser S, Yakut C, Ozdemir R, Karakilinc H, Ozalan S, Marshall SF, et al. Cancer incidence rates in Turkey in 2006: a detailed registry based estimation. Asian Pac J Cancer Prev. 2010;11(6):1731-9
  • Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 1, lower urinary tract. AJR Am J Roentgenol. 2009;192(6):1481-7.
  • Malats N, Real FX. Epidemiology of bladder cancer. Hematol Oncol Clin North Am. 2015 Apr;29(2):177-89.
  • Noyes N, Knopman JM, Long K, Coletta JM, Abu-Rustum NR. Fertility considerations in the management of gynecologic malignancies. Gynecol Oncol. 2011;120(3):326-33.
  • Cummings KC, 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012;116(4):797-806.
  • de Oliveira GS, Jr., Ahmad S, Schink JC, Singh DK, Fitzgerald PC, McCarthy RJ. Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery. Reg Anesth Pain Med. 2011;36(3):271-7.
  • Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis. British journal of anaesthesia. 2011;106(6):814-22.
  • Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. British journal of anaesthesia. 2010;105(2):106-15.
  • Welters ID. Is immunomodulation by opioid drugs of clinical relevance? Current opinion in anaesthesiology. 2003;16(5):509-13.
  • Yamaguchi K, Takagi Y, Aoki S, Futamura M, Saji S. Significant detection of circulating cancer cells in the blood by reverse transcriptase-polymerase chain reaction during colorectal cancer resection. Annals of surgery. 2000;232(1):58-65.
  • Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Surgery for gastric cancer increases plasma levels of vascular endothelial growth factor and von Willebrand factor. Gastric Cancer. 2002;5(3):137-41. 12. Schietroma M, Pessia B, Stifini D, Lancione L, Carlei F, Cecilia EM, et al. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study. J Minim Access Surg. 2016;12(2):109-17.
  • Lacassie HJ, Cartagena J, Branes J, Assel M, Echevarria GC. The relationship between neuraxial anesthesia and advanced ovarian cancer-related outcomes in the Chilean population. Anesthesia and analgesia. 2013;117(3):653-60.
  • Roiss M, Schiffmann J, Tennstedt P, Kessler T, Blanc I, Goetz A, et al. Oncological long-term outcome of 4772 patients with prostate cancer undergoing radical prostatectomy: does the anaesthetic technique matter? Eur J Surg Oncol. 2014;40(12):1686-92.
  • Wuethrich PY, Thalmann GN, Studer UE, Burkhard FC. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer. PloS one. 2013; 8(8): e72873.
  • Jang D, Lim CS, Shin YS, Ko YK, Park SI, Song SH, et al. A comparison of regional and general anesthesia effects on 5-year survival and cancer recurrence after transurethral resection of the bladder tumor: a retrospective analysis. BMC anesthesiology. 2016 12; 16:16.
  • Chipollini J, Alford B, Boulware DC, Forget P, Gilbert SM, Lockhart JL, et al. Epidural anesthesia and cancer outcomes in bladder cancer patients: is it the technique or the medication? A matched-cohort analysis from a tertiary referral center. BMC anesthesiology. 2018 3;18(1):157.
  • Ben-Eliyahu S, Page GG, Yirmiya R, Shakhar G. Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. Int J Cancer. 1999 15;80(6):880-8.
  • 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.
  • Vallejo R, de Leon-Casasola O, Benyamin R. Opioid therapy and immunosuppression: a review. Am J Ther. 2004;11(5):354-65.
  • Grandhi RK, Lee S, Abd-Elsayed A. The Relationship Between Regional Anesthesia and Cancer: A Metaanalysis. Ochsner J. 2017;17(4):345-61.
  • Zhao H, Iwasaki M, Yang J, Savage S, Ma D. Hypoxia-inducible factor-1: a possible link between inhalational anesthetics and tumor progression? Acta Anaesthesiol Taiwan. 2014;52(2):70-6.
  • Vaghari BA, Ahmed OI, Wu CL. Regional anesthesia-analgesia: relationship to cancer recurrence and infection. Anesthesiology clinics. 2014;32(4):841-51.
  • Gupta K, Kshirsagar S, Chang L, Schwartz R, Law PY, Yee D, et al. Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Res. 2002 1;62(15):4491-8.
  • Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E, Hohne C, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. British J Anaesth. 2008;101(6):781-7.
  • Moselli NM, Baricocchi E, Ribero D, Sottile A, Suita L, Debernardi F. Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia. Ann Surg Oncol. 2011;18(10):2722-31.
  • Yardeni IZ, Beilin B, Mayburd E, Alcalay Y, Bessler H. Relationship between fentanyl dosage and immune function in the postoperative period. J Opioid Manag. 2008;4(1):27-33.

The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis

Year 2020, Volume: 9 Issue: 1, 1 - 7, 08.04.2020
https://doi.org/10.5505/abantmedj.2020.05902

Abstract

INTRODUCTION: Data investigating the role of regional anesthesia on survival in bladder cancer is lacking. This retrospective study aimed to compare the impact of regional anesthesia and general anesthesia on survival in patients who underwent surgery for bladder cancer.

METHODS: A total of 181 patients (mean age 62±11 years, 82 % male) who underwent surgery for bladder cancer were enrolled in this retrospective study. All data were collected from patient case charts. Patients were divided into two study groups according to the type of anesthesia used: Regional anesthesia group (RA Group) (n=120) and general anesthesia group (GA Group) (n=61).

RESULTS: Three-years survival following surgery was significantly higher in patients receiving regional anesthesia compared to those receiving general anesthesia (96.6% vs. 86.8%, p=0.012). Logistic regression analyses showed that postoperative infection (OR: 0.221, 95 % CI: 0.065-0.754, p=0.016) and implementation of regional anesthesia (OR: 4.275, 95 % CI: 1.230-14.852, p=0.020) were predictive for 3-years survival.

DISCUSSION AND CONCLUSION: Findings of the present study demonstrate that regional anesthesia provides better 3-year survival compared to general anesthesia in patients undergoing surgery for bladder cancer. Postoperative infections and anesthesia technique are the predictors of survival in these patients.

References

  • Eser S, Yakut C, Ozdemir R, Karakilinc H, Ozalan S, Marshall SF, et al. Cancer incidence rates in Turkey in 2006: a detailed registry based estimation. Asian Pac J Cancer Prev. 2010;11(6):1731-9
  • Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 1, lower urinary tract. AJR Am J Roentgenol. 2009;192(6):1481-7.
  • Malats N, Real FX. Epidemiology of bladder cancer. Hematol Oncol Clin North Am. 2015 Apr;29(2):177-89.
  • Noyes N, Knopman JM, Long K, Coletta JM, Abu-Rustum NR. Fertility considerations in the management of gynecologic malignancies. Gynecol Oncol. 2011;120(3):326-33.
  • Cummings KC, 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012;116(4):797-806.
  • de Oliveira GS, Jr., Ahmad S, Schink JC, Singh DK, Fitzgerald PC, McCarthy RJ. Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery. Reg Anesth Pain Med. 2011;36(3):271-7.
  • Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis. British journal of anaesthesia. 2011;106(6):814-22.
  • Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. British journal of anaesthesia. 2010;105(2):106-15.
  • Welters ID. Is immunomodulation by opioid drugs of clinical relevance? Current opinion in anaesthesiology. 2003;16(5):509-13.
  • Yamaguchi K, Takagi Y, Aoki S, Futamura M, Saji S. Significant detection of circulating cancer cells in the blood by reverse transcriptase-polymerase chain reaction during colorectal cancer resection. Annals of surgery. 2000;232(1):58-65.
  • Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Surgery for gastric cancer increases plasma levels of vascular endothelial growth factor and von Willebrand factor. Gastric Cancer. 2002;5(3):137-41. 12. Schietroma M, Pessia B, Stifini D, Lancione L, Carlei F, Cecilia EM, et al. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study. J Minim Access Surg. 2016;12(2):109-17.
  • Lacassie HJ, Cartagena J, Branes J, Assel M, Echevarria GC. The relationship between neuraxial anesthesia and advanced ovarian cancer-related outcomes in the Chilean population. Anesthesia and analgesia. 2013;117(3):653-60.
  • Roiss M, Schiffmann J, Tennstedt P, Kessler T, Blanc I, Goetz A, et al. Oncological long-term outcome of 4772 patients with prostate cancer undergoing radical prostatectomy: does the anaesthetic technique matter? Eur J Surg Oncol. 2014;40(12):1686-92.
  • Wuethrich PY, Thalmann GN, Studer UE, Burkhard FC. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer. PloS one. 2013; 8(8): e72873.
  • Jang D, Lim CS, Shin YS, Ko YK, Park SI, Song SH, et al. A comparison of regional and general anesthesia effects on 5-year survival and cancer recurrence after transurethral resection of the bladder tumor: a retrospective analysis. BMC anesthesiology. 2016 12; 16:16.
  • Chipollini J, Alford B, Boulware DC, Forget P, Gilbert SM, Lockhart JL, et al. Epidural anesthesia and cancer outcomes in bladder cancer patients: is it the technique or the medication? A matched-cohort analysis from a tertiary referral center. BMC anesthesiology. 2018 3;18(1):157.
  • Ben-Eliyahu S, Page GG, Yirmiya R, Shakhar G. Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. Int J Cancer. 1999 15;80(6):880-8.
  • 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.
  • Vallejo R, de Leon-Casasola O, Benyamin R. Opioid therapy and immunosuppression: a review. Am J Ther. 2004;11(5):354-65.
  • Grandhi RK, Lee S, Abd-Elsayed A. The Relationship Between Regional Anesthesia and Cancer: A Metaanalysis. Ochsner J. 2017;17(4):345-61.
  • Zhao H, Iwasaki M, Yang J, Savage S, Ma D. Hypoxia-inducible factor-1: a possible link between inhalational anesthetics and tumor progression? Acta Anaesthesiol Taiwan. 2014;52(2):70-6.
  • Vaghari BA, Ahmed OI, Wu CL. Regional anesthesia-analgesia: relationship to cancer recurrence and infection. Anesthesiology clinics. 2014;32(4):841-51.
  • Gupta K, Kshirsagar S, Chang L, Schwartz R, Law PY, Yee D, et al. Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Res. 2002 1;62(15):4491-8.
  • Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E, Hohne C, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. British J Anaesth. 2008;101(6):781-7.
  • Moselli NM, Baricocchi E, Ribero D, Sottile A, Suita L, Debernardi F. Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia. Ann Surg Oncol. 2011;18(10):2722-31.
  • Yardeni IZ, Beilin B, Mayburd E, Alcalay Y, Bessler H. Relationship between fentanyl dosage and immune function in the postoperative period. J Opioid Manag. 2008;4(1):27-33.
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Gülseren Yılmaz This is me 0000-0003-2984-156X

Publication Date April 8, 2020
Submission Date November 25, 2019
Published in Issue Year 2020 Volume: 9 Issue: 1

Cite

APA Yılmaz, G. (2020). The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis. Abant Medical Journal, 9(1), 1-7. https://doi.org/10.5505/abantmedj.2020.05902
AMA Yılmaz G. The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis. Abant Med J. April 2020;9(1):1-7. doi:10.5505/abantmedj.2020.05902
Chicago Yılmaz, Gülseren. “The Effect of Anesthesia Choice on Survival in Patients Undergoing Surgery for Bladder Cancer: A Retrospective Analysis”. Abant Medical Journal 9, no. 1 (April 2020): 1-7. https://doi.org/10.5505/abantmedj.2020.05902.
EndNote Yılmaz G (April 1, 2020) The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis. Abant Medical Journal 9 1 1–7.
IEEE G. Yılmaz, “The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis”, Abant Med J, vol. 9, no. 1, pp. 1–7, 2020, doi: 10.5505/abantmedj.2020.05902.
ISNAD Yılmaz, Gülseren. “The Effect of Anesthesia Choice on Survival in Patients Undergoing Surgery for Bladder Cancer: A Retrospective Analysis”. Abant Medical Journal 9/1 (April 2020), 1-7. https://doi.org/10.5505/abantmedj.2020.05902.
JAMA Yılmaz G. The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis. Abant Med J. 2020;9:1–7.
MLA Yılmaz, Gülseren. “The Effect of Anesthesia Choice on Survival in Patients Undergoing Surgery for Bladder Cancer: A Retrospective Analysis”. Abant Medical Journal, vol. 9, no. 1, 2020, pp. 1-7, doi:10.5505/abantmedj.2020.05902.
Vancouver Yılmaz G. The effect of anesthesia choice on survival in patients undergoing surgery for bladder cancer: a retrospective analysis. Abant Med J. 2020;9(1):1-7.