术中右美托咪定与腹腔镜结直肠癌切除术后全因死亡率及复发之间的关联：一项既往随机对照试验的随访分析
Association between intraoperative dexmedetomidine and all-cause mortality and recurrence after laparoscopic resection of colorectal cancer: Follow-up analysis of a previous randomized controlled trial.
作者信息
Hu Jingping, Gong Chulian, Xiao Xue, Chen Liubing, Zhang Yihan, Li Xiaoyue, Li Yanting, Zang Xiangyang, Huang Pinjie, Zhou Shaoli, Chen Chaojin
机构信息
Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Front Oncol. 2023 Mar 30;13:906514. doi: 10.3389/fonc.2023.906514. eCollection 2023.
BACKGROUND
Dexmedetomidine (DEX) has been widely applied in the anesthesia and sedation of patients with oncological diseases. However, the potential effect of DEX on tumor metastasis remains contradictory. This study follows up on patients who received intraoperative DEX during laparoscopic resection of colorectal cancer as part of a previous clinical trial, examining their outcomes 5 years later.
METHODS
Between June 2015 and December 2015, 60 patients undergoing laparoscopic colorectal resection were randomly assigned to the DEX and control groups. The DEX group received an initial loading dose of 1μ/kg before surgery, followed by a continuous infusion of 0.3μg/kg/h during the operation and the Control group received an equivalent volume of saline. A 5-year follow-up analysis was conducted to evaluate the overall survival, disease-free survival, and tumor recurrence.
RESULTS
The follow-up analysis included 55 of the 60 patients. The DEX group included 28 patients, while the control group included 27 patients. Baseline characteristics were comparable between the two groups, except for vascular and/or neural invasion of the tumor in the DEX group (9/28 vs. 0/27, = 0.002). We did not observe a statistically significant benefit but rather a trend toward an increase in overall survival and disease-free survival in the DEX group, 1-year overall survival (96.4% vs. 88.9%, = 0.282), 2-year overall survival (89.3% vs. 74.1%, = 0.144), 3-year overall survival (89.3% vs. 70.4%, = 0.08), and 5-year overall survival (78.6% vs. 59.3%, = 0.121). The total rates of mortality and recurrence between the two groups were comparable (8/28 vs. 11/27, = 0.343).
CONCLUSION
Administration of DEX during laparoscopic resection of colorectal cancer had a nonsignificant trend toward improved overall survival and disease-free survival.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn/, identifier ChiCTRIOR-15006518.
背景
右美托咪定（DEX）已广泛应用于肿瘤疾病患者的麻醉和镇静。然而，DEX对肿瘤转移的潜在影响仍存在矛盾。本研究对作为先前一项临床试验一部分在腹腔镜结直肠癌切除术中接受术中DEX的患者进行随访，5年后检查其预后情况。
方法
2015年6月至2015年12月期间，60例行腹腔镜结直肠癌切除术的患者被随机分配至DEX组和对照组。DEX组在手术前接受1μg/kg的初始负荷剂量，然后在手术期间以0.3μg/（kg·h）的速度持续输注，对照组接受等量的生理盐水。进行5年的随访分析以评估总生存期、无病生存期和肿瘤复发情况。
结果
随访分析纳入了60例患者中的55例。DEX组包括28例患者，对照组包括27例患者。两组之间的基线特征具有可比性，但DEX组肿瘤的血管和/或神经侵犯情况除外（9/28对0/27，P = 0.002）。我们未观察到统计学上的显著益处，而是DEX组有总生存期和无病生存期增加的趋势，1年总生存期（96.4%对88.9%，P = 0.282），2年总生存期（89.3%对74.1%，P = 0.144），3年总生存期（89.3%对70.4%，P = 0.08），以及5年总生存期（78.6%对59.3%，P = 0.121）。两组之间的总死亡率和复发率具有可比性（8/28对11/27，P = 0.343）。
结论
在腹腔镜结直肠癌切除术中给予DEX有改善总生存期和无病生存期的不显著趋势。
临床试验注册
http://www.chictr.org.cn/，标识符ChiCTRIOR - 15006518。
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