Pain drugs used during prostate gland removal linked to cancer outcome

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The methods used to anesthetize patients with prostate cancer and control pain due to surgical resection of the prostate glands for adenocarcinoma may affect patients' long-term cancer outcomes, a study has found.

Opioids, painkillers commonly given during and after surgery, may suppress the immune system's ability to fight cancer cells. The research suggests that supplementing general anesthesia with a spinal or epidural painkiller before a radical prostatectomy reduces a patient's need for opioids after surgery. This finding was associated with a lower risk of cancer recurrence. The findings, led by researchers at the Mayo Clinic in Rochester, Minnesota, were published in the British Journal of Anaesthesia (2013; doi:10.1093/bja/aet467).

The immune system's strength is especially important in cancer surgery because surgical manipulation of a tumor may spread cancer cells. The immune system can be impaired by general anesthesia, by the overall stress surgery places on the body, and by postsurgical systemic opioid use.

The study found that patients who underwent radical prostatectomy had better outcomes when general anesthesia was supplemented with spinal or epidural delivery of a long-acting opioid, such as morphine, compared with patients who received general anesthesia only.

"We found a significant association between this opioid-sparing technique, reduced progression of the prostate tumor, and overall mortality," said senior author Juraj Sprung, MD, PhD, a Mayo Clinic anesthesiologist.

Researchers used Mayo Clinic's prostatectomy registry, anesthesia database, and electronic medical records to identify patients who had prostate gland surgery for adenocarcinoma between January 1991 and December 2005. Reports of recurrence of cancer, cancer spread, and death were confirmed with patients' physicians.

Although promising, the findings must be tested in randomized trials. Sprung said, "Provided future studies confirm what we've found in this study, maybe down the line this would be a standard of care for pain management in patients undergoing cancer surgery."

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