Impact of regional anesthesia on cancer survival to be debated

Can Regional Anesthesia/Analgesia Improve Oncological Outcomes? Fact or Fiction
Wednesday, 9-10 a.m.
Upper 23A-C

There have long been questions about the impact of anesthesia used during cancer surgery on long-term survival. The evidence to date points both ways.

“There have been 14 or 15 studies on this issue so far,” said Juan Cata, M.D., Assistant Professor of Anesthesiology and Perioperative Medicine at the University of Texas MD Anderson Cancer Center. “Some of them have shown positive results and some have negative results. We don’t really know the answer.”

Dr. Cata will moderate a debate that asks “Can Regional Anesthesia/Analgesia Improve Oncological Outcomes? Fact or Fiction” from 9 to 10 a.m. today in Upper 23A-C. Andrea M. Kurz, M.D., Associate Director of the Outcomes Research Consortium and Chair of General Anesthesia at the Cleveland Clinic, will argue that regional anesthesia is not associated with improved long-term survival. Daniel I. Sessler, M.D., Professor and Director of the Outcomes Research Consortium, will argue that regional anesthesia can improve long-term survival.

The question in this debate may seem simple, but the answer is not. The thought is that the perioperative period following cancer surgery includes immunosuppression, angiogenesis and an increased load of circulating tumor cells. This set of conditions could encourage tumors to seed, invade and proliferate. The hypothesis is that the use of regional anesthesia rather than general anesthesia could reduce surgical stress, opioid consumption and the use of volatile gasses, which would in turn reduce perioperative immune suppression, angiogenesis and, in the long run, cancer recurrence to prolong survival.

Experimental evidence suggests that the use of regional anesthesia can, indeed, improve the long-term survival of patients with cancer. Studies in non-cancer surgeries have shown reduced rates of morbidity and mortality associated with a variety of regional anesthesia techniques. But the results of more recent clinical trials in cancer surgeries conflict with that experimental evidence.

In general, Dr. Cata said, older studies support the notion of improved survival associated with the use of regional anesthesia during cancer surgeries. More recent studies are less supportive of the notion.

“This is a topic where the evidence is not at all clear and a lot of anesthesiologists still have questions about the best course of action or how to determine what the best course of action might be for any particular patient,” he said. “Posing this question is not a surprise because regional anesthesia versus general anesthesia is a question that comes up all the time in anesthesiology. The real excitement here in San Diego is that we are going to have two of the very best outcomes researchers in the world discussing what has become one of the hottest topics in anesthesia.

“And this is not just an academic question. Cancer is the No. 2 cause of death in the United States. If we can make an impact on that burden of mortality, that would be a great move forward for our patients and for our specialty.”

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