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Epidural Anesthesia-analgesia and Long-term Outcome

2017-01-09 03:31:35 | BioPortfolio

Summary

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.

Description

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.

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention

Conditions

Elderly Patients

Intervention

Combined Epi-GA/PCEA, GA/PCIA

Location

Beijing University First Hospital
Beijing
Beijing
China
100034

Status

Active, not recruiting

Source

Peking University First Hospital

Results (where available)

View Results

Links

Published on BioPortfolio: 2017-01-09T03:31:35-0500

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