• Anesthesiology · Oct 2006

    Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis?

    This controversy-starting retrospective study reported a 30% reduction in 3 year recurrence-free survival after undergoing mastectomy for primary breast cancer in patients who received a traditional general anaesthetic with morphine analgesia, compared with those receiving a regional (paravertebral) technique.

    Although plausible biological mechanisms have been suggested and even demonstrated in vitro, the huge treatment effect is yet to be replicated in better quality retrospective or prospective trials.

    30% reduction in cancer-free survival

    Evidence to date does not (yet) support this trial’s findings.

    "An extraordinary claim requires extraordinary proof." – Marcello Truzzi

    summary
    • Aristomenis K Exadaktylos, Donal J Buggy, Denis C Moriarty, Edward Mascha, and Daniel I Sessler.
    • University Department of Anaesthesia and Intensive Care Medicine, Mater Misericordiae University Hospital, National Breast Screening Program-Eccles Unit, Dublin 7, Ireland.
    • Anesthesiology. 2006 Oct 1; 105 (4): 660-4.

    BackgroundRegional 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.MethodsIn 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.ResultsFifty 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).ConclusionsThis 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.

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    This article appears in the collection: Anesthesia technique and cancer recurrence.

    Notes

    summary
    1

    This controversy-starting retrospective study reported a 30% reduction in 3 year recurrence-free survival after undergoing mastectomy for primary breast cancer in patients who received a traditional general anaesthetic with morphine analgesia, compared with those receiving a regional (paravertebral) technique.

    Although plausible biological mechanisms have been suggested and even demonstrated in vitro, the huge treatment effect is yet to be replicated in better quality retrospective or prospective trials.

    30% reduction in cancer-free survival

    Evidence to date does not (yet) support this trial’s findings.

    "An extraordinary claim requires extraordinary proof." – Marcello Truzzi

    Daniel Jolley  Daniel Jolley
     
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