Outcomes after radical prostatectomy for cancer: A comparison between general anesthesia and epidural anesthesia with fentanyl analgesia: A matched cohort study

Juraj Sprung, Federica Scavonetto, Tze Yeng Yeoh, Jessica M. Kramer, Robert Jeffrey Karnes, John H. Eisenach, Darrell R. Schroeder, Toby N. Weingarten

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: The use of regional anesthesia for cancer surgery has been associated with improved oncologic outcomes. One of the proposed mechanisms is a reduction in the use of systemic opioids that may cause immunosuppression. We used a retrospective matched cohort design to compare long-term oncologic outcomes after prostatectomy for cancer performed under general anesthesia with systemic opioids or with epidural anesthesia with epidural fentanyl analgesia. Since epidural fentanyl is quickly reabsorbed systemically, we hypothesized that there would be no difference in long-term oncological outcomes between the 2 groups.

Methods: There were 486 men who underwent prostatectomy performed under epidural anesthesia between January 1, 1991, and January 31, 1996. They were 1:1 matched based on age (±5 years), surgical year (±1 year), and baseline prostate cancer pathology to patients who had general anesthesia with systemic opioids. Long-term cancer outcomes and all-cause mortality were examined. Analyses were performed using stratified proportional hazards regression models, with hazard ratios >1 indicating worse outcome for general anesthesia only compared with epidural anesthesia and fentanyl analgesia.

Results: After adjusting for positive surgical margins and adjuvant therapies, patients in the general anesthesia group were found not to be at increased risk of prostate cancer recurrence (hazard ratio [HR] = 0.79, 95% confidence interval [CI], 0.60-1.04], systemic tumor progression (HR = 0.92, 95% CI, 0.46-1.84), cancer-specific mortality (HR = 0.53, 95% CI, 0.18-1.58), or overall mortality (HR = 1.23, 95% CI 0.93-1.63) when compared with patients who received epidural anesthesia.

Conclusions: Compared with general anesthesia with systemic opioids, epidural anesthesia and analgesia with fentanyl were not associated with improvement in oncologic outcomes in patients undergoing radical prostatectomy for cancer.

Original languageEnglish (US)
Pages (from-to)859-866
Number of pages8
JournalAnesthesia and Analgesia
Volume119
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

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Epidural Anesthesia
Fentanyl
Prostatectomy
Analgesia
General Anesthesia
Cohort Studies
Opioid Analgesics
Confidence Intervals
Anesthesia and Analgesia
Neoplasms
Epidural Analgesia
Mortality
Prostatic Neoplasms
Conduction Anesthesia
Proportional Hazards Models
Immunosuppression
Pathology
Recurrence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Outcomes after radical prostatectomy for cancer : A comparison between general anesthesia and epidural anesthesia with fentanyl analgesia: A matched cohort study. / Sprung, Juraj; Scavonetto, Federica; Yeoh, Tze Yeng; Kramer, Jessica M.; Karnes, Robert Jeffrey; Eisenach, John H.; Schroeder, Darrell R.; Weingarten, Toby N.

In: Anesthesia and Analgesia, Vol. 119, No. 4, 2014, p. 859-866.

Research output: Contribution to journalArticle

Sprung, Juraj ; Scavonetto, Federica ; Yeoh, Tze Yeng ; Kramer, Jessica M. ; Karnes, Robert Jeffrey ; Eisenach, John H. ; Schroeder, Darrell R. ; Weingarten, Toby N. / Outcomes after radical prostatectomy for cancer : A comparison between general anesthesia and epidural anesthesia with fentanyl analgesia: A matched cohort study. In: Anesthesia and Analgesia. 2014 ; Vol. 119, No. 4. pp. 859-866.
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abstract = "Background: The use of regional anesthesia for cancer surgery has been associated with improved oncologic outcomes. One of the proposed mechanisms is a reduction in the use of systemic opioids that may cause immunosuppression. We used a retrospective matched cohort design to compare long-term oncologic outcomes after prostatectomy for cancer performed under general anesthesia with systemic opioids or with epidural anesthesia with epidural fentanyl analgesia. Since epidural fentanyl is quickly reabsorbed systemically, we hypothesized that there would be no difference in long-term oncological outcomes between the 2 groups.Methods: There were 486 men who underwent prostatectomy performed under epidural anesthesia between January 1, 1991, and January 31, 1996. They were 1:1 matched based on age (±5 years), surgical year (±1 year), and baseline prostate cancer pathology to patients who had general anesthesia with systemic opioids. Long-term cancer outcomes and all-cause mortality were examined. Analyses were performed using stratified proportional hazards regression models, with hazard ratios >1 indicating worse outcome for general anesthesia only compared with epidural anesthesia and fentanyl analgesia.Results: After adjusting for positive surgical margins and adjuvant therapies, patients in the general anesthesia group were found not to be at increased risk of prostate cancer recurrence (hazard ratio [HR] = 0.79, 95{\%} confidence interval [CI], 0.60-1.04], systemic tumor progression (HR = 0.92, 95{\%} CI, 0.46-1.84), cancer-specific mortality (HR = 0.53, 95{\%} CI, 0.18-1.58), or overall mortality (HR = 1.23, 95{\%} CI 0.93-1.63) when compared with patients who received epidural anesthesia.Conclusions: Compared with general anesthesia with systemic opioids, epidural anesthesia and analgesia with fentanyl were not associated with improvement in oncologic outcomes in patients undergoing radical prostatectomy for cancer.",
author = "Juraj Sprung and Federica Scavonetto and Yeoh, {Tze Yeng} and Kramer, {Jessica M.} and Karnes, {Robert Jeffrey} and Eisenach, {John H.} and Schroeder, {Darrell R.} and Weingarten, {Toby N.}",
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T1 - Outcomes after radical prostatectomy for cancer

T2 - A comparison between general anesthesia and epidural anesthesia with fentanyl analgesia: A matched cohort study

AU - Sprung, Juraj

AU - Scavonetto, Federica

AU - Yeoh, Tze Yeng

AU - Kramer, Jessica M.

AU - Karnes, Robert Jeffrey

AU - Eisenach, John H.

AU - Schroeder, Darrell R.

AU - Weingarten, Toby N.

PY - 2014

Y1 - 2014

N2 - Background: The use of regional anesthesia for cancer surgery has been associated with improved oncologic outcomes. One of the proposed mechanisms is a reduction in the use of systemic opioids that may cause immunosuppression. We used a retrospective matched cohort design to compare long-term oncologic outcomes after prostatectomy for cancer performed under general anesthesia with systemic opioids or with epidural anesthesia with epidural fentanyl analgesia. Since epidural fentanyl is quickly reabsorbed systemically, we hypothesized that there would be no difference in long-term oncological outcomes between the 2 groups.Methods: There were 486 men who underwent prostatectomy performed under epidural anesthesia between January 1, 1991, and January 31, 1996. They were 1:1 matched based on age (±5 years), surgical year (±1 year), and baseline prostate cancer pathology to patients who had general anesthesia with systemic opioids. Long-term cancer outcomes and all-cause mortality were examined. Analyses were performed using stratified proportional hazards regression models, with hazard ratios >1 indicating worse outcome for general anesthesia only compared with epidural anesthesia and fentanyl analgesia.Results: After adjusting for positive surgical margins and adjuvant therapies, patients in the general anesthesia group were found not to be at increased risk of prostate cancer recurrence (hazard ratio [HR] = 0.79, 95% confidence interval [CI], 0.60-1.04], systemic tumor progression (HR = 0.92, 95% CI, 0.46-1.84), cancer-specific mortality (HR = 0.53, 95% CI, 0.18-1.58), or overall mortality (HR = 1.23, 95% CI 0.93-1.63) when compared with patients who received epidural anesthesia.Conclusions: Compared with general anesthesia with systemic opioids, epidural anesthesia and analgesia with fentanyl were not associated with improvement in oncologic outcomes in patients undergoing radical prostatectomy for cancer.

AB - Background: The use of regional anesthesia for cancer surgery has been associated with improved oncologic outcomes. One of the proposed mechanisms is a reduction in the use of systemic opioids that may cause immunosuppression. We used a retrospective matched cohort design to compare long-term oncologic outcomes after prostatectomy for cancer performed under general anesthesia with systemic opioids or with epidural anesthesia with epidural fentanyl analgesia. Since epidural fentanyl is quickly reabsorbed systemically, we hypothesized that there would be no difference in long-term oncological outcomes between the 2 groups.Methods: There were 486 men who underwent prostatectomy performed under epidural anesthesia between January 1, 1991, and January 31, 1996. They were 1:1 matched based on age (±5 years), surgical year (±1 year), and baseline prostate cancer pathology to patients who had general anesthesia with systemic opioids. Long-term cancer outcomes and all-cause mortality were examined. Analyses were performed using stratified proportional hazards regression models, with hazard ratios >1 indicating worse outcome for general anesthesia only compared with epidural anesthesia and fentanyl analgesia.Results: After adjusting for positive surgical margins and adjuvant therapies, patients in the general anesthesia group were found not to be at increased risk of prostate cancer recurrence (hazard ratio [HR] = 0.79, 95% confidence interval [CI], 0.60-1.04], systemic tumor progression (HR = 0.92, 95% CI, 0.46-1.84), cancer-specific mortality (HR = 0.53, 95% CI, 0.18-1.58), or overall mortality (HR = 1.23, 95% CI 0.93-1.63) when compared with patients who received epidural anesthesia.Conclusions: Compared with general anesthesia with systemic opioids, epidural anesthesia and analgesia with fentanyl were not associated with improvement in oncologic outcomes in patients undergoing radical prostatectomy for cancer.

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