Table 2.
Retrospective studies assessing local anesthetics impact on cancer prognosis.
| Cancer | Patients | Design | Cancer prognosis outcome | Ref |
|---|---|---|---|---|
| Breast | N=79 | Control group: general anesthesia (sevoflurane) | Studied group: lower recurrence- and metastasis-free survival (p=0.012) | (14) |
| Postoperative: PCA (morphine) | ||||
| N=50 | Studied group: general anesthesia (sevoflurane) + PVB (bolus and infusion of levobupivacaine for 48h) | |||
| Cervical | N=69 | Control group: general anesthesia | Studied group: not associated with lower cancer burden or a reduced risk of tumor recurrence and mortality | (106) |
| N=63 | Studied group: neuraxial anaesthesia (spinal and epidural analgesia) | |||
| Colon | N=2 299 | Control group: general anesthesia + opioid-based analgesia | No association between epidural analgesia and recurrence or death | (107) |
| N=449 | Studied group: loading dose of lidocaine + general anesthesia and epidural anesthesia (bupivacaine with or without fentanyl for 48-72h) | |||
| Colon | N=668 | Control group: general anesthesia | Peridural analgesia:not associated with better oncological outcome | (108) |
| N=208 | Studied group: epidural anesthesia | |||
| Colon | N=189 | Control group: general anesthesia | Epidural analgesia: better 5-year survival (p=0.01) | (8) |
| N=399 | Studied group: epidural anesthesia | |||
| Colon | N=253 | Control group: general anesthesia | Epidural: lower cancer recurrence in patients older than 64 years | (109) |
| N=256 | Studied group: epidural anesthesia | |||
| Colon | N=32 481 | Control group: general anesthesia | Epidural anesthesia: improved survival (p<0.001) | (103) |
| N=9 670 | Studied group: epidural anesthesia | |||
| Colo-rectal | N=93 | Control group: general anesthesia sevoflurane or desflurane + fentanyl and IV morphine for 2 to 5 days | Epidural anesthesia: lower mortality in the sub-group of rectal cancer (p=0.049) | (110) |
| N=562 | Studied group: general anesthesia sevoflurane or desflurane + epidural (bolus local anesthetic and fentanyl or local anesthetic alone and infusion of local anesthetic with fentanyl or local anesthetic and morphine for 2-5 days) | |||
| Colo-rectal | N=173 | Control group: PCA (morphine) | No significant difference in overall survival or disease-free survival at 5 years | (111) |
| N=107 | Studied group: epidural anesthesia (Bolus and infusion of bupivacaine with fentanyl for 48h) | |||
| N=144 | Studied group: spinal anesthesia (bupivacaine with morphine) | |||
| Colo-rectal | N=307 | Control group: general anesthesia (isoflurane or desflurane + fentanyl) | Epidural analgesia: greater long-term survival (p<0.02) | (9) |
| N=442 | Studied group: general anesthesia (isoflurane or desflurane + fentanyl) + epidural analgesia | |||
| Colo-rectal + liver metastases | N=120 | Control group: IV anesthesia | Epidural anesthesia: improved five-year recurrence free survival (p=0.036) | (104) |
| N=390 | Studied group: epidural anesthesia | |||
| Gastro-oeso-phageal | N=140 (total) | Control group: general anesthesia (sevoflurane or propofol infusion) + IV opioid analgesia | Epidural was associated with 2-year recurrence and overall survival benefit (p<0.0001) | (105) |
| Studied group: general anesthesia (sevoflurane or propofol) + epidural anesthesia (bupivacaine bolus + infusion with morphine for 96h) | ||||
| ENT | N=160 | Control group: general anesthesia + morphine | Epidural anesthesia:increased cancer-free survival (p=0.04) and overall survival (p=0.03) | (112) |
| N=111 | Studied group: general anesthesia + epidural anesthesia | |||
| Liver | N=244 | Control group: general anesthesia (sevoflurane or propofol) + sufentanil + nonsteroidal anti-inflammatory drugs | Local anesthetic increased recurrence free survival (p=0.002) and overall survival (p=0.036) | (12) |
| N=245 | Studied group: lidocaine+nonsteroidal anti-inflammatory drugs | |||
| Melanoma | N=221 | Control group: general anesthesia (isoflurane or propofol) + sufentanil or remifentanil | Spinal anesthesia: a trend of better cumulative survival rate | (113) |
| N=52 | Studied group: spinal anesthesia (bupivacaine) | |||
| NSCLC | NA | Control group: general anestheisa (isoflurane, sevoflurane or desflurane) + IV opioid analgesia; postoperative PCA (hydromorphone, fentanyl or morphine) | No difference on recurrence-free survival or overall survival | (114) |
| Studied group: general anesthesia (isoflurane, sevoflurane or desflurane) + IV opioid analgesia | ||||
| Postoperative: epidural (bupivacaine + fentanyl or bupivacaine + hydromorphone or ropivacaine and fentanyl) | ||||
| Studied group: general anesthesia (isoflurane, sevoflurane, or desflurane) + IV opioid analgesia | ||||
| Postoperative: epidural/PCA: bupivacaine + fentanyl or bupivacaine + hydromorphone or ropivacaine + fentanyl | ||||
| Ovary | N=37 | Control group: general anesthesia (sevoflurane or isoflurane) + PCA fentanyl | Epidural anesthesia: greater 3- and 5-year overall survival rates (p=0.043) | (10) |
| N=106 | Studied group: epidural anesthesia (Infusion of bupivacaine or ropivacaine and morphine for 48h) | |||
| Ovary | N=43 | Control group: general anesthesia (volatile + fentanyl) | Epidural anesthesia: not associated with improved overall survival or time to recurrence | (115) |
| Postoperative: ketorolac and PCA (morphine) | ||||
| N=37 | Studied group: general anesthesia +epidural anesthesia (bolus of bupivacaine with or without fentanyl); Postoperative: ketorolac and epidural for 48h | |||
| Pancreas | N=2 239 (total) | Control group: general anesthesia (sevoflurane) + epidural analgesia (ropivacaine) | Lidocaine group:longer overall survival (p=0.013) | (11) |
| Studied group:lidocaine bolus+ continuous infusion + general anesthesia (sevoflurane) + epidural analgesia (ropivacaine); | ||||
| Prostate | N=123 | Control group: general anesthesia(propofol) + fentanyl | Epidural anesthesia: lower risk of recurrence (p=0.012) | (13) |
| Postoperative: PCA (morphine) | ||||
| N=102 | Studied group: general anesthesia (propofol) + fentanyl | |||
| Postoperative: local anesthetic infusion for 48-72h | ||||
| Prostate | N=158 | Control group: general anesthesia (isoflurane) + fentanyl; Postoperative: ketorolac + paracetamol | Epidural analgesia: improved clinical progression-free survival (p=0.002). | (116) |
| N=103 | Studied group: general anesthesia (isoflurane) + Epidural (bupivacaine) + fentanyl | |||
| Prostate | N=533 | Control group: intravenous analgesia | Epidural analgesia:not associated with a significant effect | (117) |
| N=578 | Studied group: epidural analgesia | |||
| Visceral | N=63 | Control group: general anesthesia (isoflurane + fentanyl); | A trend in favor of epidural anesthesia was observed for recurrence free survival | (118) |
| Postoperative: morphine | ||||
| N=69 | Epidural group: bupivacaine + general anesthesia (isoflurane); postoperative: bupivacaine + morphine |
IV, intravenous; PCA, patient-controlled analgesia; PVB, paravertebral block.
PCA, patient-controlled analgesia; IV, intravenous.