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This one act during surgery could affect your cancer reoccurrence

Tracy Woolrich's picture
Anesthesia given during prostate cancer surgery

An interesting correlation was published in December 2013 in the British Journal of Anesthesia online. Researchers found that the type of anesthesia given during prostate surgery may affect reoccurrence outcomes.

I was immediately interested in reading about this as my father died in 1997 from prostate cancer. It should never have happened in my opinion, as he was diagnosed in 1990 as stage I. It was well differentiated and contained within the prostate with no cells found elsewhere. However his surgeon was less than stellar and the blood loss during the procedure was vast making visualization very difficult. Obviously he did not remove the cancerous growth completely allowing it to reoccur 5 years later. However, after reading this report it makes me wonder if there were other possible causes for the spread.

Researchers reviewed the records for over 3,000 men that had prostate cancer surgery between 1991 and 2005 at the Mayo Clinic. They found that those who were given both general plus a regional epidural had a lower risk of reoccurrence than men who received only general anesthesia.
They looked at records for men over a period of 15 years. 5% of men given only general anesthesia had their cancer reoccur in their bones. Men who also received regional anesthesia (epidural) had a recurrence level of 3%.

The researchers looked at other factors during the study such as the staging of the cancer and what other treatments were given post op such as using Lupron (hormonal therapy). In conclusion however, having general anesthesia alone was thought to be linked to cancer metastasizing to distant areas of the body over the next 15 years.

Decreased immunity
"We can't conclude from this that it's cause-and-effect," said senior researcher Dr Juraj Sprung, an anesthesiologist at the Mayo Clinic in Rochester, Minnesota. He indicated however those using spinal pain killing opiods would reduce the patient’s need for additional narcotics post op. The use of large amounts of post operative narcotics such as morphine may decrease the immune system.

That is crucial because during prostate cancer surgery (like any cancer surgery), some cancer cells are released into the bloodstream. A strong active immune system would be able to fight them off. An immune system that is reduced in any way, may affect the outcome.

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According to the National Institute of Health, cellular immunity defenders such as cytotoxic T cells and macrophages, provide continuous internal surveillance. Their job is to catch and eliminate malignant cells.

"If you avoid opioids after surgery, you may be increasing your ability to fight off these cancer cells," Sprung said.

In addition, some past studies have seen a similar pattern in patients having surgery for other cancers such as colon, ovarian and breast, Sprung said.

Laparoscopic approach

It is important to note, that in this study all of the men had an open radical prostatectomy. That is fairly “old school” in this day and age of laparoscopic surgery. These days, using laparoscopy, only a few small minimally invasive cuts are made through the use of robotics.

Using this technique causes less blood loss, less stress and a lot less pain. Therefore there is less need for opiods post operatively. Therefore, by using this method it almost makes this research useless. Or does it? Remember, this study may extend to other cancer surgeries as well and it would be prudent to investigate this information further.

Does it really matter?

Dr David Samadi, the chief of urology at Lenox Hill Hospital in New York City, says that is there is only 3%- 5% reoccurrence, the risk is still low. He suggested that patients and their family should be more concerned about their surgeon's expertise than the type of anesthesia that is being used. "It's not the robot," Samadi said. "It's the experience of the surgeon."

I tend to agree, and feel that my father’s death was directly related to a surgeon technique.
Take home message: To find a qualified urologist search online and find one that does not have a lot of malpractice issues. Do not just assume that if the insurance company approves the surgeon he is qualified. Get a second opinion to see if radiation or seeding would be more appropriate.

For more information on Prostate Cancer, click on this link from the American Cancer Society.

SOURCES: Juraj Sprung, M.D., Ph.D., professor, anesthesiology, Mayo Clinic, Rochester, Minn.; David Samadi, M.D., chairman, urology, Lenox Hill Hospital, New York City; Dec. 17, 2013, British Journal of Anesthesia, online