Müller Sarah D, Both Christian P, Sponholz Christoph, Voelker Maria Theresa, Christiansen Holger, Niggli Felix, Schmitz Achim, Weiss Markus, Thomas Jörg, Stehr Sebastian N, Piegeler Tobias
Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany.
Department of Anesthesia, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
Cancers (Basel). 2022 Nov 14;14(22):5585. doi: 10.3390/cancers14225585.
Recent data suggest that anesthesiologic interventions-e.g., the choice of the anesthetic regimen or the administration of blood products-might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients.
A retrospective multicenter study assessing data from pediatric patients (0-18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes.
In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36-42.2, = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42-68.4, = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio.
The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.
近期数据表明，麻醉干预措施，例如麻醉方案的选择或血液制品的输注，可能在决定肿瘤手术后的预后方面发挥重要作用。与成年患者不同，关于麻醉与小儿癌症患者预后之间潜在关联的数据有限。
在欧洲的三个学术中心开展了一项回顾性多中心研究，评估2004年至2018年间接受肾母细胞瘤手术的儿科患者（0至18岁）的数据。总生存率和无复发生存率是该研究的主要结局，并评估了术中输注红细胞浓缩液、使用区域麻醉和麻醉方案选择的潜在影响。重症监护病房住院时间、术后出院时间和血液中性粒细胞与淋巴细胞比值被定义为次要结局。
总共分析了65例患者的数据。术中输注红细胞浓缩液与无复发生存率降低相关（风险比（HR）7.59，95%置信区间（CI）1.36 - 42.2，P = 0.004），而总生存率未受影响（HR 5.37，95% CI 0.42 - 68.4，P = 0.124）。区域麻醉的使用和维持麻醉所用麻醉剂的选择对主要结局未显示出影响。然而，它与较少的重症监护病房转科、缩短的出院时间和术后降低的中性粒细胞与淋巴细胞比值相关。
本研究首次提供证据表明输血以及麻醉干预与小儿癌症手术后的预后之间可能存在关联。
