Breast cancer recurrence in patients receiving epidural and paravertebral anesthesia: A retrospective, case-control study

Purpose: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia. Methods: A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer. Patients identified as receiving regional anesthesia were then matched for age, stage, estrogen receptor (ER) status, progesterone receptor status, and HER-2 expression with patients who received no regional anesthesia. Univariate (Pearson’s χ² test and odds ratio) and multivariate logistic analyses with backward stepwise regression were performed to determine factors associated with cancer recurrence. Results: Between 1998 and 2007, 816 women underwent surgery for stage 0-III breast cancer at our institution. Forty-five patients developed tumors. Univariate analysis showed the use of regional anesthesia trended towards reduced cancer recurrence, but it did not achieve statistical significance (p=0.06). Higher recurrence rates were associated with ER positive status (p=0.003) and higher tumor stage (p <0.0001). Age and HER-2 status were not associated with increased cancer recurrence (both p>0.11). Multivariate analysis confirmed ER status and stage as independently influential (p = 0.002 and p<0.0001 respectively). Conclusion: Although we found a trend towards reduced breast cancer recurrence with the use of regional anesthesia, univariate analysis did not reach statistical significance.