TY - JOUR
T1 - Prise en charge périopératoire et devenirs oncologiques après une cystectomie radicale pour un cancer de la vessie
T2 - une étude rétrospective de cohorte appariée
AU - Weingarten, Toby N.
AU - Taccolini, Ashley M.
AU - Ahle, Samuel T.
AU - Dietz, Kelsey R.
AU - Dowd, Shaun S.
AU - Frank, Igor
AU - Boorjian, Stephen A.
AU - Thapa, Prabin
AU - Hanson, Andrew C.
AU - Schroeder, Darrell R.
AU - Sprung, Juraj
N1 - Funding Information:
The Research Electronic Data Capture (REDCap) system is supported by a Center for Translational Science Activities grant (UL1 TR000135). This research was carried out with our departmental Small Grant Program. The funders played no role in the design or conduct of the study, including collection, management, analysis, and interpretation of the data and preparation and review of the manuscript. ®
Publisher Copyright:
© 2016, Canadian Anesthesiologists' Society.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Purpose: The immune system plays an important role in tumour progression. Systemic opioids are immunosuppressive; thus, theoretically they may promote tumour spread. Our primary aim was to test the hypothesis that general anesthesia (GA) with spinal analgesia (SA) in patients with bladder cancer undergoing radical cystectomy (RC) will both reduce systemic opioid use and improve oncological outcomes. Since blood transfusions also induce immunosuppression, a secondary aim was to evaluate the effect of perioperative transfusions on oncological outcomes. Methods: One hundred ninety-five patients who underwent RC with GA+SA from 1998-2007 were matched 1:1 to controls who underwent surgery with GA only using propensity scoring and tumour characteristics known to be highly associated with oncological outcomes. Medical records were reviewed for use of opioids and transfusions. Outcomes were tumour recurrence, cancer-specific mortality, and all-cause mortality. Survival was estimated using the Kaplan-Meier method, and associations of anesthetic technique and transfusions with outcomes were analyzed using stratified multivariable proportional hazard regression. Results: Systemic opioid use was reduced with GA+SA relative to GA (P < 0.001). There was no difference between groups with respect to all-cause mortality (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.77 to 1.53; P = 0.636), bladder cancer mortality (HR, 1.03; 95% CI, 0.66 to 1.61; P = 0.893), or cancer recurrence (HR, 1.32; 95% CI, 0.86 to 2.02; P = 0.205). Nevertheless, patients who were perioperatively transfused had an increased all-cause mortality (HR, 2.21; 95% CI, 1.11 to 4.40; P = 0.025), and cancer-specific mortality (HR, 2.61; 95% CI, 1.05 to 6.48; P = 0.039). Conclusions: In patients undergoing RC, the opioid-sparing effect with SA was not associated with improved oncological outcomes, while blood transfusion was associated with increased mortality.
AB - Purpose: The immune system plays an important role in tumour progression. Systemic opioids are immunosuppressive; thus, theoretically they may promote tumour spread. Our primary aim was to test the hypothesis that general anesthesia (GA) with spinal analgesia (SA) in patients with bladder cancer undergoing radical cystectomy (RC) will both reduce systemic opioid use and improve oncological outcomes. Since blood transfusions also induce immunosuppression, a secondary aim was to evaluate the effect of perioperative transfusions on oncological outcomes. Methods: One hundred ninety-five patients who underwent RC with GA+SA from 1998-2007 were matched 1:1 to controls who underwent surgery with GA only using propensity scoring and tumour characteristics known to be highly associated with oncological outcomes. Medical records were reviewed for use of opioids and transfusions. Outcomes were tumour recurrence, cancer-specific mortality, and all-cause mortality. Survival was estimated using the Kaplan-Meier method, and associations of anesthetic technique and transfusions with outcomes were analyzed using stratified multivariable proportional hazard regression. Results: Systemic opioid use was reduced with GA+SA relative to GA (P < 0.001). There was no difference between groups with respect to all-cause mortality (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.77 to 1.53; P = 0.636), bladder cancer mortality (HR, 1.03; 95% CI, 0.66 to 1.61; P = 0.893), or cancer recurrence (HR, 1.32; 95% CI, 0.86 to 2.02; P = 0.205). Nevertheless, patients who were perioperatively transfused had an increased all-cause mortality (HR, 2.21; 95% CI, 1.11 to 4.40; P = 0.025), and cancer-specific mortality (HR, 2.61; 95% CI, 1.05 to 6.48; P = 0.039). Conclusions: In patients undergoing RC, the opioid-sparing effect with SA was not associated with improved oncological outcomes, while blood transfusion was associated with increased mortality.
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U2 - 10.1007/s12630-016-0599-9
DO - 10.1007/s12630-016-0599-9
M3 - Article
C2 - 26850064
AN - SCOPUS:84957547044
VL - 63
SP - 584
EP - 595
JO - Canadian Journal of Anesthesia
JF - Canadian Journal of Anesthesia
SN - 0832-610X
IS - 5
ER -