Track topics on Twitter Track topics that are important to you
Surgical resection is one of the most important treatments for malignant tumor; on the other hand, tumor recurrence and/or metastasis are the major reasons of treatment failure. The outcome after surgery mostly depends on the balance between the immunity of human body and the capability of implantation, proliferation and neovascularization of the tumor. Preclinical and retrospective studies suggest that anaesthetic techniques and drugs may affect the long-term prognosis in patients undergoing cancer surgery. The investigators hypothesize that epidural anesthesia-analgesia may improve the long-term outcome of the elderly patients who are scheduled to undergo major thoracic and abdominal surgery for the treatment of malignant tumor.
Surgical resection is the main treatment for potentially curable solid tumors. However, it is unavoidable that some tumor cells are disseminated into the circulatory or lymphatic system during surgery. And quite a number of patients develop tumor metastasis and/or recurrence after surgery, which are associated with poor long-term outcome. The development of tumor recurrence and/or metastasis after surgery is mostly dependent on the balance between the anti-tumor immune function of the human body and the ability of implantation, proliferation and neovascularization of the tumor cells.
Multiple surgical factors may influence the balance between the anti-tumor immune function and tumor recurrence. For example, the presence of the primary tumor inhibits angiogenesis, whereas tumor resection eliminates this safeguard against angiogenesis; surgical manipulation releases tumor cells into the circulation; surgical response inhibits natural killer (NK) cell activity and can promote the development of tumor metastases; local and systemic release of growth factors during surgery may also promote tumor recurrence both locally and at distant sites.
Furthermore, studies show that general anaesthetic techniques and drugs may influence the cellular immune function and long-term outcome. For example, it was found that ketamine and thiopental, but not propofol, suppressed NK cell activity; all three drugs caused a significant reduction in NK cell number; isoflurane and halothane inhibit interferon (IFN) stimulation of NK cell cytotoxicity; nitrous oxide interferes with DNA, purine, and thymidylate synthesis and depresses neutrophil chemotaxis; opioids have been shown to suppress cell-mediated and humoral immunity.
Considering the potential harmful effects of general anesthesia/anesthetics, there is increasing interest on the effect of regional anaesthesia. Retrospective studies investigating the relationship between epidural anesthesia and outcome after cancer surgery give different results. In a meta-analysis, regional anesthesia was associated with increased the survival rate (HR = 0.84, 95% confidence interval [CI] 0.74-0.96, P = 0.013), but had no effect on the rate of tumor recurrence/metastasis (HR = 0.88, 95% Cl 0.64-1.22, P = 0.457). The investigators hypothesize that epidural anesthesia may produce favorable effects on the long-term outcome of the elderly patients who were scheduled for major cancer surgery under general anesthesia. However, there is no sufficient evidence in this aspect.
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Combined Epi-GA/PCEA, GA/PCIA
Beijing University First Hospital
Active, not recruiting
Peking University First Hospital
Published on BioPortfolio: 2017-01-09T03:31:35-0500
Surgical resection is one of the most important treatments for solid organ cancer. Whereas cancer recurrence and/or metastasis are the major reasons of treatment failure. The outcomes afte...
Some studies suggest that regional anesthesia/analgesia may decrease the rate of recurrence/metastasis in patients after cancer surgery. However, evidences from prospective studies are sti...
Total hip replacement (THR) is frequently followed by high pain experience. Epidural analgesia is a mainstay in postoperative treatment in patients after THR. The investigators found that ...
The purpose of this randomized controlled trial is to investigate the effects of epidural anesthesia and analgesia on the overall survival，disease-free survival and recovery in patients ...
The purpose of this randomized controlled clinical trial is to investigate the effects of epidural block on overall survival，disease-free survival and recovery in patients with pancreati...
Although lung cancer is most commonly diagnosed in elderly patients, evidence about tumor-directed therapy in elderly patients is sparse, and it is unclear to what extent this affects treatment and ca...
The number of elderly patients with end-stage renal disease on maintenance dialysis therapy is gradually increasing. The elderly population has difficulties in making decisions regarding initiation of...
Hodgkin lymphoma (HL), a disease of mostly young patients, also peaks in the elderly. Despite the profound improvement in the outcome of young patients, in the elderly, 5-year progression-free surviva...
The incidence of neuroendocrine tumors (NETs) is rising, especially in elderly patients. The elderly cancer population present considerable challenges, yet little is known about the characteristics, t...
Gastroesophageal reflux disease (GERD) is an especially common disorder in the elderly population. Its presentation in this population is often different from that in younger patients. A greater prop...
Housing arrangements for the elderly or aged, intended to foster independent living. The housing may take the form of group homes or small apartments. It is available to the economically self-supporting but the concept includes housing for the elderly with some physical limitations. The concept should be differentiated from HOMES FOR THE AGED which is restricted to long-term geriatric facilities providing supervised medical and nursing services.
Group of rare congenital disorders characterized by impairment of both humoral and cell-mediated immunity, leukopenia, and low or absent antibody levels. It is inherited as an X-linked or autosomal recessive defect. Mutations occurring in many different genes cause human Severe Combined Immunodeficiency (SCID).
A cardioselective ADRENERGIC BETA-1 RECEPTOR ANTAGONIST (beta-blocker) that functions as a VASODILATOR through the endothelial L-arginine/ NITRIC OXIDE system. It is used to manage HYPERTENSION and chronic HEART FAILURE in elderly patients.
Organizations which provide an environment encouraging social interactions through group activities or individual relationships especially for the purpose of rehabilitating or supporting patients, individuals with common health problems, or the elderly. They include therapeutic social clubs.
A short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. The short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. It is water-soluble at pH less than 4 and lipid-soluble at physiological pH.
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...
Allergies Automimmune Disease Human Papillomavirus (HPV) Immunology Vaccine Immunology is the study of immunity and the defence mechanisms of the body. A greater understanding of immunology is needed to develop vaccines, understand ...
Bladder Cancer Brain Cancer Breast Cancer Cancer Cervical Cancer Colorectal Head & Neck Cancers Hodgkin Lymphoma Leukemia Lung Cancer Melanoma Myeloma Ovarian Cancer Pancreatic Cancer ...