前列腺癌根治术后的结局：全身麻醉与芬太尼镇痛硬膜外麻醉的比较：一项匹配队列研究。

Outcomes after radical prostatectomy for cancer: a comparison between general anesthesia and epidural anesthesia with fentanyl analgesia: a matched cohort study.

作者信息

Sprung Juraj, Scavonetto Federica, Yeoh Tze Yeng, Kramer Jessica M, Karnes R Jeffrey, Eisenach John H, Schroeder Darrell R, Weingarten Toby N

机构信息

From the Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Anesthesiology, National University Hospital, National University Health System, Republic of Singapore; Midwest Anesthesiologists, P.A., Plymouth, Minnesota; and Department of Urology and Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota.

出版信息

Anesth Analg. 2014 Oct;119(4):859-866. doi: 10.1213/ANE.0000000000000320.

DOI:10.1213/ANE.0000000000000320

PMID:24977632

Abstract

BACKGROUND

The use of regional anesthesia for cancer surgery has been associated with improved oncologic outcomes. One of the proposed mechanisms is a reduction in the use of systemic opioids that may cause immunosuppression. We used a retrospective matched cohort design to compare long-term oncologic outcomes after prostatectomy for cancer performed under general anesthesia with systemic opioids or with epidural anesthesia with epidural fentanyl analgesia. Since epidural fentanyl is quickly reabsorbed systemically, we hypothesized that there would be no difference in long-term oncological outcomes between the 2 groups.

METHODS

There were 486 men who underwent prostatectomy performed under epidural anesthesia between January 1, 1991, and January 31, 1996. They were 1:1 matched based on age (±5 years), surgical year (±1 year), and baseline prostate cancer pathology to patients who had general anesthesia with systemic opioids. Long-term cancer outcomes and all-cause mortality were examined. Analyses were performed using stratified proportional hazards regression models, with hazard ratios >1 indicating worse outcome for general anesthesia only compared with epidural anesthesia and fentanyl analgesia.

RESULTS

After adjusting for positive surgical margins and adjuvant therapies, patients in the general anesthesia group were found not to be at increased risk of prostate cancer recurrence (hazard ratio [HR] = 0.79, 95% confidence interval [CI], 0.60-1.04], systemic tumor progression (HR = 0.92, 95% CI, 0.46-1.84), cancer-specific mortality (HR = 0.53, 95% CI, 0.18-1.58), or overall mortality (HR = 1.23, 95% CI 0.93-1.63) when compared with patients who received epidural anesthesia.

CONCLUSIONS

Compared with general anesthesia with systemic opioids, epidural anesthesia and analgesia with fentanyl were not associated with improvement in oncologic outcomes in patients undergoing radical prostatectomy for cancer.

摘要

背景

区域麻醉用于癌症手术已被证明与改善肿瘤学预后相关。一种提出的机制是减少可能导致免疫抑制的全身性阿片类药物的使用。我们采用回顾性匹配队列设计，比较全身麻醉联合全身性阿片类药物与硬膜外麻醉联合硬膜外芬太尼镇痛下行前列腺癌根治术后的长期肿瘤学预后。由于硬膜外芬太尼可迅速被全身重吸收，我们推测两组的长期肿瘤学预后无差异。

方法

1991年1月1日至1996年1月31日期间，有486名男性在硬膜外麻醉下行前列腺切除术。根据年龄（±5岁）、手术年份（±1年）和基线前列腺癌病理情况，将他们与接受全身麻醉联合全身性阿片类药物的患者进行1:1匹配。检查长期癌症预后和全因死亡率。使用分层比例风险回归模型进行分析，风险比>1表明仅全身麻醉与硬膜外麻醉和芬太尼镇痛相比预后更差。

结果

在调整手术切缘阳性和辅助治疗后，发现全身麻醉组患者与接受硬膜外麻醉的患者相比，前列腺癌复发风险未增加（风险比[HR]=0.79，95%置信区间[CI]，0.60 - 1.04），全身肿瘤进展风险（HR = 0.92，95% CI，0.46 - 1.84），癌症特异性死亡率（HR = 0.53，95% CI，0.18 - 1.58）或总死亡率（HR = 1.23，95% CI 0.93 - 1.63）。