Department of Anesthesiology, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
BMC Anesthesiol. 2024 Jan 10;24(1):19. doi: 10.1186/s12871-023-02400-w.
The influence of anesthesia techniques on cancer recurrence and metastasis following oncological surgery is a topic of growing interest. This meta-analysis investigates the potential effects of regional anesthesia (RA), either independently or combined with general anesthesia (GA), on these outcomes.
We performed an extensive search across PubMed, Embase, and the Cochrane Library databases. The primary outcome was cancer recurrence, while the secondary outcomes were local recurrence and distant metastasis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by utilizing random-effects models. The Newcastle-Ottawa Scale (NOS) was used for quality assessment of observational studies, the Cochrane Risk of Bias Tool for Randomized Trials (Rob 2.0) was used for randomized controlled trials, and all the outcomes were assessed by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
This study included 32 studies comprising 24,724 cancer patients. RA, either alone or in combination with GA, was significantly associated with reduced cancer recurrence compared to GA alone (OR = 0.82; 95% CI = 0.72 to 0.94; p < 0.01). This association remained significant for prostate cancer patients in subgroup analyses (OR = 0.71; 95% CI = 0.51 to 0.98; p = 0.04) and in the context of epidural anesthesia combined with GA. However, there were no significant associations noted for local recurrence or distant metastasis.
This meta-analysis provides evidence that RA, used alone or adjunctively with GA, is associated with a lower risk of cancer recurrence, particularly in patients with prostate cancer. However, no significant effects were observed on local recurrence or distant metastasis. Further prospective studies should be conducted to clarify this important issue.
麻醉技术对肿瘤手术后癌症复发和转移的影响是一个日益受到关注的话题。本荟萃分析研究了局部麻醉（RA），无论是单独使用还是与全身麻醉（GA）联合使用，对这些结果的潜在影响。
我们对 PubMed、Embase 和 Cochrane 图书馆数据库进行了广泛搜索。主要结局是癌症复发，次要结局是局部复发和远处转移。使用随机效应模型计算合并的优势比（OR）及其 95%置信区间（CI）。使用纽卡斯尔-渥太华量表（NOS）评估观察性研究的质量，使用 Cochrane 随机试验偏倚风险工具（Rob 2.0）评估随机对照试验，使用推荐分级、评估、制定与评价（GRADE）评估所有结局。
本研究纳入了 32 项研究，共包括 24724 例癌症患者。与单独使用 GA 相比，RA 单独或与 GA 联合使用与癌症复发风险降低显著相关（OR=0.82；95%CI=0.72 至 0.94；p<0.01）。亚组分析显示，这种关联在前列腺癌患者中仍然显著（OR=0.71；95%CI=0.51 至 0.98；p=0.04），且在硬膜外麻醉联合 GA 的情况下也显著。然而，局部复发或远处转移未见显著关联。
本荟萃分析提供了证据表明，RA 单独使用或与 GA 联合使用与癌症复发风险降低相关，尤其是在前列腺癌患者中。然而，对局部复发或远处转移没有显著影响。应开展进一步的前瞻性研究来阐明这个重要问题。
