TO STUDY EFFECT OF REGIONAL ANESTHESIA ON PREVENTION OF RECURRENCE OF COLORECTAL CARCINOMA

Main Article Content

Dr Sumit Kumar Singh
Dr Priyanka Awasthi
Dr Rahul Saket
Dr. Aman Kumar
Dr. Zulfiqar Ali
Prof. Alok Kumar

Keywords

Abstract

Colorectal cancer is a prevalent condition, with an approximate annual global incidence of 1.8 million cases. Given the projected rise in its occurrence, this disease is increasingly posing a significant global health concern. Surgical intervention continues to be the principal therapeutic modality for the management of colorectal cancer. However, the occurrence of cancer recurrence after surgery is prevalent, constituting the leading cause of mortality among those afflicted with this ailment. Paradoxically, the physiological stress induced by curative surgery has the potential to create a conducive microenvironment for the progression of cancer, affecting both the immunological and neuro-humoral systems. The perioperative period holds significant importance in the progression of metastasis and cancer reoccurrence. To gain a comprehensive understanding of the impact of perioperative regional anesthesia on metastasis and tumors recurrence, it is crucial to consider the perioperative window within its appropriate context. Typically, individuals diagnosed with solid tumors can be effectively treated with surgical interventions, either with or without the inclusion of pre and post-surgical adjuvant therapies such as radiation treatment, chemotherapy, or hormone therapy. The outcomes obtained from the assessment of the utilization of RA in colorectal tumors exhibit a heterogeneous pattern. The benefits of regional anesthesia are influenced by several key criteria, namely the stage and type of colorectal cancer, the patient's age, the timing of epidural administration, and the American Society of Anesthesiology physical state classification. Research has demonstrated that RA does not provide any significant advantages in terms of overall survival, recurrence-free survival, and biochemical recurrence-free survival.

Abstract 188 | pdf Downloads 153

References

1. Arnold M, Abnet CC, Neale RE, Vignat J, Giovannucci EL, McGlynn KA, Bray F: Global burden of 5 major types of gastrointestinal cancer. Gastroenterology 2020; 159:335–349.e15.
2. Fitzmaurice C, Akinyemiju TF, Lami FH Al, Alam T, Alizadeh-Navaei R, Allen C, Alsharif U, Alvis-Guzman N, Amini E, Anderson BO, Aremu O, Artaman A, Asgedom SW, Assadi R, Atey TMH, Avila-Burgos L, Awasthi A, Saleem HO, Barac A, Topor-Madry, Tran TT, Tran BX, Ukwaja KN, Vlassov VV, Vollset SE, Weiderpass E, Williams HC, Yimer NB, Yonemoto N, Younis MZ, Murray CJL, Naghavi M: Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: A systematic analysis for the global burden of disease study. JAMA Oncol 2018; 4:1553–68.
3. Pilleron S, Soto-Perez-de-Celis E, Vignat J, Ferlay J, Soerjomataram I, Bray F, Sarfati D: Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer 2021; 148:601–8.
4. Cottet V, Bouvier V, Rollot F, Jooste V, Bedenne L, Faivre J, Launoy G, Bouvier AM: Incidence and patterns of late recurrences in rectal cancer patients. Ann Surg Oncol 2015; 22:520–7.
5. Holmes AC, Riis AH, Erichsen R, Fedirko V, Ostenfeld EB, Vyberg M, Thorlacius-Ussing O, Lash TL: Descriptive characteristics of colon and rectal cancer recurrence in a Danish population-based study. Acta Oncol 2017; 56:1111–9.
6. Demicheli R, Retsky MW, Hrushesky WJ, Baum M, Gukas ID: The effects of surgery on tumor growth: a century of investigations. Ann Oncol 2008; 19:1821–8.
7. Forget P, Aguirre JA, Bencic I, Borgeat A, Cama A, Condron C, Eintrei C, Eroles P, Gupta A, Hales TG, Ionescu D, Johnson M, Kabata P, Kirac I, Ma D, Mokini Z, Guerrero Orriach JL, Retsky M, Sandrucci S, Siekmann W, Štefančić L, Votta-Vellis G, Connolly C, Buggy D: How anesthetic, analgesic and other non-surgical techniques during cancer surgery might affect postoperative oncologic outcomes: A summary of current state of evidence. Cancers (Basel) 2019; 11:E592
8. MacCarthy-Morrogh L, Martin P: The hallmarks of cancer are also the hallmarks of wound healing. Sci Signal 2020; 13:eaay8690
9. Wall T, Sherwin A, Ma D, Buggy DJ: Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: A narrative review. Br J Anaesth 2019; 123:135–50
10. Horowitz M, Neeman E, Sharon E, Ben-Eliyahu S: Exploiting the critical perioperative period to improve long-term cancer outcomes. Nat Rev Clin Oncol 2015; 12:213–26.
11. Dockrell L, Buggy DJ: The role of regional anaesthesia in the emerging subspecialty of onco-anaesthesia: A state-of-the-art review. Anaesthesia 2021; 76 (suppl 1):148–59
12. Cusack B, Buggy DJ: Anaesthesia, analgesia, and the surgical stress response. BJA Educ 2020; 20:321–8.
13. Fant F, Tina E, Sandblom D, Andersson SO, Magnuson A, Hultgren-Hörnkvist E, Axelsson K, Gupta A: Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy. Br J Anaesth 2013; 110:747–57.
14. Hiller JG, Perry NJ, Poulogiannis G, Riedel B, Sloan EK: Perioperative events influence cancer recurrence risk after surgery. Nat Rev Clin Oncol 2018; 15:205–18.
15. Tedore T: Regional anaesthesia and analgesia: Relationship to cancer recurrence and survival. Br J Anaesth 2015; 115:ii34–45.
16. Makito K, Matsui H, Fushimi K, Yasunaga H: Volatile versus total intravenous anesthesia for cancer prognosis in patients having digestive cancer surgery. Anesthesiology 2020; 133:764–73.
17. M. Fukata and M. Arditi, “The role of pattern recognition receptors in intestinal inflammation,”Mucosal Immunology, 2013; 6(3)451–463.
18. E. M. Creagh and L. A. J. O’Neill, “TLRs, NLRs and RLRs: a trinity of pathogen sensors that co-operate in innate immunity,” Trends in Immunology, 2006; 27(8): 352–357.
19. S. Rakoff-Nahoum, J. Paglino, F. Eslami-Varzaneh, S. Edberg, and R. Medzhitov, “Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis,” Cell 2004; 118( 2):229–241.
20. Y. S. Hyun, D. S. Han, A. R. Lee, C. S. Eun, J. Youn, and H.-Y. Kim, “Role of IL-17A in the development of colitis-associated cancer,” Carcinogenesis, vol. 33, no. 4, pp. 931–936, 2012.
21. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth 2010;105:106–15.
22. van der Bij GJ, Oosterling SJ, Beelen RH, et al. The perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer. Ann Surg 2009;249:727–34.
23. Langley RR, Fidler IJ. The seed and soil hypothesis revisited–the role of tumor-stroma interactions in metastasis to different organs. Int J Cancer 2011; 128:2527–35.
24. Gottschalk A, Ford JG, Regelin CC, et al. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology. 2010 Jul;113(1):27-34.
25. Christopherson R, James KE, Tableman M, Marshall P, Johnson FE. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia. Anesth Analg. 2008 Jul; 107(1):325-332.
26. Gupta A, Bjo¨ rnsson A, Fredriksson M, Hallbo¨o¨ k O, Eintrei C. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden. Br J Anaesth. 2011 Aug;107(2):164-170.
27. Holler JP, Ahlbrandt J, Burkhardt E, et al. Peridural analgesia may affect long-term survival in patients with colorectal cancer after surgery (PACO-RAS-Study): an analysis of a cancer registry. Ann Surg. 2013 Dec;258(6):989-993.
28. Cummings KC 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012 Apr;116(4):797-806.
29. Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI; ANZCA Trials Group Investigators. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial. BMJ. 2011 Mar 29; 342:d1491.
30. Day A, Smith R, Jourdan I, Fawcett W, Scott M, Rockall T. Retrospective analysis of the effect of postoperative analgesia on survival in patients after laparoscopic resection of colorectal cancer. Br J Anaesth. 2012 Aug;109(2):185-190.
31. Binczak M, Tournay E, Billard V, Rey A, Jayr C. Major abdominal surgery for cancer: does epidural analgesia have a long-term effect on recurrence-free and overall survival? Ann Fr Anesth Reanim. 2013 May;32(5):e81-e88.
32. Heinrich S, Janitz K, Merkel S, Klein P, Schmidt J. Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery. Langenbecks Arch Surg. 2015 Jan;400(1):19-26.
33. Lai R, Peng Z, Chen D, et al. The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg. 2012 Feb; 114(2):290-296.
34. Day A, Smith R, Jourdan I, Fawcett W, Scott M, Rockall T. Retrospective analysis of the effect of postoperative analgesia on survival in patients after laparoscopic resection of colorectal cancer. Br J Anaesth 2012;109:185-90.
35. Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI; ANZCA Trials Group Investigators. Perioperative epiduralanalgesia for major abdominal surgery for cancer andrecurrence-free survival: Randomised trial. BMJ 2011;342:d1491.
36. Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia andoutcome of major surgery: A randomised trial. Lancet 2002;359:1276-82.
37. Binczak M, Tournay E, Billard V, Rey A, Jayr C. Major abdominal surgery for cancer: Does epidural analgesia have a long-term effect on recurrence-free and overall survival? Ann Fr Anesth Reanim 2013;32:81-8.
38. Lai R, Peng Z, Chen D,Wang X, Xing W, Zeng W. The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg 2012;114:290-6.

Most read articles by the same author(s)