Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?
Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?
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DOI：
10.1097/00000542-200610000-00008
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发表时间：
2006-10-01
期刊：
影响因子：
8.8
通讯作者：
Sessler, Daniel I.
中科院分区：
文献类型：
--
作者：
Exadaktylos, Aristomenis K.;Buggy, Donal J.;Sessler, Daniel I.
背景：已知区域麻醉可以预防或减弱手术应激反应；因此，通过椎旁麻醉抑制手术应激可能会减弱促进肿瘤生长和扩散的围手术期因素。作者假设，接受椎旁麻醉和镇痛联合全身麻醉进行手术的乳腺癌患者比接受全身麻醉和患者自控吗啡镇痛进行手术的乳腺癌患者的癌症复发或转移发生率更低。 方法：在这项回顾性研究中，作者检查了 2001 年 9 月至 12 月期间连续 129 名因乳腺癌接受乳房切除术和腋窝清除术的患者的医疗记录2002年结果：50例患者采用椎旁麻醉镇痛联合全身麻醉，79例患者采用全身麻醉联合术后吗啡镇痛。随访时间为 32 +/- 5 个月（平均值 +/- SD）。患者或手术细节、肿瘤表现或预后因素没有显着差异。椎旁麻醉和全身麻醉患者的 24 个月无复发和无转移生存率分别为 94%（95% 置信区间，87-100%）和 82%（74-91%），36 个月时分别为 94%（87-100%）和 77%（68-87%）（P = 0.012）。 结论：这项回顾性分析表明乳腺癌手术的椎旁麻醉和镇痛可降低随访最初几年复发或转移的风险。评估区域镇痛和吗啡用量减少对癌症复发的影响的前瞻性试验似乎是有必要的。
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.