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Lani · 09-29-2006, 05:15 PM

1: Anesthesiology. 2006 Oct;105(4):660-664. Links
Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis?

Exadaktylos AK,
Buggy DJ,
Moriarty DC,
Mascha E,
Sessler DI.
* Research Fellow in Anaesthesia, Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland. dagger Consultant in Anaesthesia, Mater Misericordiae University Hospital and National Breast Screening Programme (Eccles Unit), and Honorary Senior Lecturer in Anaesthesia, University College, Dublin, Ireland. double dagger Professor of Anaesthesia, Mater Misericordiae University Hospital and University College, Dublin, Ireland. section sign Statistician, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. parallel Chair, Department of Outcomes Research, Cleveland Clinic Foundation Cleveland, Ohio. Director, Outcomes Research Institute, and Weakley Professor of Anesthesiology, University of Louisville, Louisville, Kentucky.
BACKGROUND:: Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. METHODS:: In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. RESULTS:: Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 +/- 5 months (mean +/- SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence- and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74-91%) at 24 months and 94% (87-100%) and 77% (68-87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P = 0.012). CONCLUSIONS:: This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted.
PMID: 17006061 [PubMed - as supplied by publisher]

09-29-2006, 05:15 PM	#1
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	could the type of anaesthesia received influences whether br cancer recurs/metastaszs 1: Anesthesiology. 2006 Oct;105(4):660-664. Links Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis? Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. * Research Fellow in Anaesthesia, Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland. dagger Consultant in Anaesthesia, Mater Misericordiae University Hospital and National Breast Screening Programme (Eccles Unit), and Honorary Senior Lecturer in Anaesthesia, University College, Dublin, Ireland. double dagger Professor of Anaesthesia, Mater Misericordiae University Hospital and University College, Dublin, Ireland. section sign Statistician, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. parallel Chair, Department of Outcomes Research, Cleveland Clinic Foundation Cleveland, Ohio. Director, Outcomes Research Institute, and Weakley Professor of Anesthesiology, University of Louisville, Louisville, Kentucky. BACKGROUND:: Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. METHODS:: In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. RESULTS:: Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 +/- 5 months (mean +/- SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence- and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74-91%) at 24 months and 94% (87-100%) and 77% (68-87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P = 0.012). CONCLUSIONS:: This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted. PMID: 17006061 [PubMed - as supplied by publisher]