Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: a retrospective analysis
Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: a retrospective analysis
复制标题
DOI：
10.1093/bja/aeu192
复制
发表时间：
2014-07-01
影响因子：
9.8
通讯作者：
Zhang, V.
中科院分区：
文献类型：
--
作者：
Maher, D. P.;Wong, W.;Zhang, V.
有证据表明，保留阿片类药物的麻醉技术可能与增加无癌术后生存率有关。这可能与围手术期阿片类镇痛药对自然杀伤细胞的抑制有关。这项回顾性分析验证了一个假设，即术后使用更多阿片类药物与肺癌术后复发率较高有关。我们回顾了99例连续接受电视胸腔镜手术并肺叶切除术的I期或IIa期非小细胞肺癌（NSCLC）患者的医疗记录。收集围手术期信息，包括患者特征、实验室数据、手术、麻醉、护理和药房报告。采用标准换算表将术中及术后96小时给予的阿片类药物剂量转换为等镇痛剂量的口服吗啡。然后将数据与国家癌症登记处5年无病生存率的发生率进行比较。最终分析共纳入99例具有相似特征的患者，其中73例在5年无NSCLC复发，26例在5年内有NSCLC复发。术后96小时内，无癌组的总阿片类药物剂量为124 (101)mg吗啡当量，复发组为232 mg (355) mg吗啡当量（P=0.02）。这项回顾性分析表明，术后最初96小时内阿片类药物剂量增加与5年内NSCLC复发率升高之间存在关联。
Evidence suggests that opioid-sparing anaesthetic techniques might be associated with increased cancer-free postoperative survival. This could be related to suppression of natural killer cells by opioid analgesics in the perioperative period. This retrospective analysis tested the hypothesis that greater opioid use in the postoperative period is associated with a higher incidence of recurrences after surgery for lung cancer.The medical records of 99 consecutive patients who underwent video-assisted thoracoscopic surgery with lobectomy for Stage I or IIa biopsy-proven non-small-cell lung cancer (NSCLC) were reviewed. Perioperative information including patient characteristics, laboratory data, and surgical, anaesthetic, nursing, and pharmacy reports were collected. Doses of opioids administered intra-operatively and for the first 96 h after operation were converted into equianalgesic doses of oral morphine using a standard conversion table. Data were then compared with the National Cancer Registry's incidence of disease-free survival for 5 yr.A total of 99 patients with similar characteristics were included in the final analysis, 73 of whom were NSCLC recurrence-free at 5 yr and 26 had NSCLC recurrence within 5 yr. Total opioid dose during the 96 h postoperative period was 124 (101) mg of morphine equivalents in the cancer-free group and 232 mg (355) mg in the recurrence group (P=0.02).This retrospective analysis suggests an association between increased doses of opioids during the initial 96 h postoperative period with a higher recurrence rate of NSCLC within 5 yr.