区域麻醉和镇痛是否能延长骨科肿瘤手术后癌症患者的生存时间？
Can regional anesthesia and analgesia prolong cancer survival after orthopaedic oncologic surgery?
机构信息
Department of Anesthesiology and Perioperative Medicine, The University of Texas-MD Anderson Cancer Center, 1515 Holcombe Blvd, Box FC13, Houston, TX, 77030, USA,
出版信息
Clin Orthop Relat Res. 2014 May;472(5):1434-41. doi: 10.1007/s11999-013-3306-y.
BACKGROUND
The perioperative period of major oncologic surgery is characterized by immunosuppression, angiogenesis, and an increased load of circulating malignant cells. It is a window period in which cancer cells may seed, invade, and proliferate. Thus, it has been hypothesized that the use of regional anesthesia with the goal of reducing surgical stress and opioid and volatile anesthetic consumption would avoid perioperative immune suppression and angiogenesis and ultimately cancer recurrence.
QUESTIONS/PURPOSES: We performed a systematic review of the literature on the use of regional anesthesia and postoperative analgesia to improve cancer-related survival after oncologic surgery. Our primary topic of interest is survival after orthopaedic oncologic surgery, but because that literature is limited, we also have systematically reviewed the question of survival after breast, gastrointestinal, and genitourologic cancers.
METHODS
We searched the PubMed and Embase databases with the search terms: "anesthesia and analgesia", "local neoplasm recurrence", "cancer recurrence", "loco-regional neoplasm recurrence", "disease-free survival", and "cumulative survival rates". Our initial search of the two databases provided 836 studies of which 693 were rejected. Of the remaining 143 studies, only 13 articles qualified for inclusion in this systematic review, based on defined inclusion criteria. All these studies had retrospective design. Due to the high heterogeneity among the identified studies and the complete absence of randomized controlled trials from the literature on this topic, the results of a meta-analysis would be heavily confounded; hence, we instead performed a systematic review of the literature.
RESULTS
No eligible studies addressed the question of whether regional anesthesia and analgesia have an impact on survival after musculoskeletal cancer surgery. Only one relevant clinical study was identified on regional breast cancer survival; it suggested a benefit. The literature on gastrointestinal and genitourinary surgery was larger but mixed, although some preliminary studies do suggest a benefit of regional anesthesia on survival after oncologic surgery in those patient populations.
CONCLUSIONS
Although basic science studies suggest a potential benefit of regional anesthesia and stress response reduction in cancer formation, we found little clinical evidence to support the theory that regional anesthesia and analgesia improve overall patient survival after oncologic surgery.
背景
在重大肿瘤外科的围手术期，机体呈现出免疫抑制、血管生成和循环中恶性肿瘤细胞负荷增加的特征。这是一个肿瘤细胞可能播种、侵袭和增殖的窗口期。因此，有人假设使用区域麻醉术来降低手术应激、减少阿片类药物和挥发性麻醉剂的使用量，将避免围手术期免疫抑制和血管生成，并最终降低癌症复发的风险。
问题/目的：我们对使用区域麻醉和术后镇痛以改善肿瘤手术后与癌症相关的生存情况进行了文献综述。我们主要关注的话题是骨科肿瘤手术后的生存情况，但由于该领域的文献有限，我们也系统地回顾了乳腺癌、胃肠道癌和泌尿生殖系统肿瘤患者的生存情况。
方法
我们使用“麻醉和镇痛”“局部肿瘤复发”“癌症复发”“局部区域肿瘤复发”“无病生存率”和“累积生存率”等检索词，在 PubMed 和 Embase 数据库中进行了检索。我们最初对这两个数据库的搜索共提供了 836 项研究，其中 693 项被排除。在剩下的 143 项研究中，只有 13 篇文章符合我们设定的纳入标准，有资格被纳入这项系统综述。所有这些研究都采用了回顾性设计。由于所确定的研究之间存在高度异质性，并且在该主题的文献中完全没有随机对照试验，因此荟萃分析的结果将受到严重混淆；因此，我们改为对文献进行系统综述。
结果
没有符合条件的研究探讨了区域麻醉和镇痛是否会对肌肉骨骼肿瘤手术后的生存产生影响。只有一项关于局部乳腺癌生存的相关临床研究，表明区域麻醉有获益。胃肠道和泌尿生殖系统手术的文献量更大，但结果较为混杂，尽管一些初步研究确实表明，在这些患者群体中，区域麻醉术可能对肿瘤手术后的生存有益。
结论
尽管基础科学研究表明区域麻醉和应激反应减轻可能对肿瘤形成有潜在益处，但我们几乎没有发现临床证据支持区域麻醉和镇痛可以改善肿瘤手术后患者的总体生存情况这一理论。
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