Lusty Avril J, Hosier Gregory W, Koti Madhuri, Chenard Stephen, Mizubuti Glenio B, Jaeger Melanie, Siemens D Robert
Department of Urology, Queen's University, Kingston, Canada.
Biomedical and Molecular Sciences, Queen's University, Kingston, Canada.
Urol Oncol. 2019 Dec;37(12):845-852. doi: 10.1016/j.urolonc.2019.08.004. Epub 2019 Sep 13.
There is increasing awareness that different anesthetic and analgesic techniques may impact outcomes after oncological surgery, generally through modifying effects on the immune system but potentially via other mechanisms including mitigating the surgical stress response. This narrative review aims to summarize the mechanisms underlying the effect of perioperative factors on oncological outcomes, with an emphasis on the available urologic literature.
Literature on anesthetic technique (i.e., general vs. regional) and oncological outcomes were reviewed with a particular focus on urological studies.
In prostate cancer surgery, the risk of mortality has been reported to be reduced with the use of regional (i.e., neuraxial) anesthesia, but there was no association between anesthetic technique and progression-free or biochemical recurrence-free survival. In nonmuscle invasive bladder cancer, regional anesthesia has been associated with lower recurrence rates and longer time to recurrence following transurethral resection of bladder tumor.
This review highlights the role of regional anesthesia to improve oncoimmunological responses after surgery, potentially through decreased use of volatile anesthetics and opioids, decreased activation of the surgical stress response, and a direct local anesthetic-mediated anti-inflammatory effect. Available urological literature suggests an association of anesthetic type and outcomes for nonmuscle invasive bladder cancer and prostate cancer surgeries but the evidence is limited. Prospective studies are needed to further investigate the relationship between anesthetic technique and urologic oncological outcomes.
人们越来越意识到，不同的麻醉和镇痛技术可能会影响肿瘤手术后的结果，通常是通过改变对免疫系统的影响，但也可能通过其他机制，包括减轻手术应激反应。本叙述性综述旨在总结围手术期因素对肿瘤学结果影响的潜在机制，重点关注现有的泌尿外科文献。
回顾了关于麻醉技术（即全身麻醉与区域麻醉）和肿瘤学结果的文献，特别关注泌尿外科研究。
在前列腺癌手术中，据报道使用区域（即神经轴）麻醉可降低死亡率，但麻醉技术与无进展生存期或无生化复发生存期之间没有关联。在非肌层浸润性膀胱癌中，区域麻醉与经尿道膀胱肿瘤切除术后较低的复发率和较长的复发时间相关。
本综述强调了区域麻醉在改善术后肿瘤免疫反应中的作用，这可能是通过减少挥发性麻醉剂和阿片类药物的使用、降低手术应激反应的激活以及直接的局部麻醉介导的抗炎作用实现的。现有的泌尿外科文献表明，麻醉类型与非肌层浸润性膀胱癌和前列腺癌手术的结果之间存在关联，但证据有限。需要进行前瞻性研究以进一步调查麻醉技术与泌尿外科肿瘤学结果之间的关系。
