Association of anesthesia technique for radical prostatectomy with biochemical recurrence: a retrospective cohort study

  • Behfar Ehdaie
  • Daniel D. Sjoberg
  • Paul H. Dalecki
  • Peter T. Scardino
  • James A. Eastham
  • David Amar
Reports of Original Investigations

Abstract

Introduction

Anesthesia technique has been associated with cancer outcomes after radical prostatectomy (RP). These studies are limited by variability in surgeon experience, bias in patient selection, and in some cases, sample size. We evaluated the impact of anesthesia technique for RP on biochemical recurrence (BCR) using a large cohort of patients operated on by a single experienced surgeon.

Methods

We retrospectively reviewed data from a prospective institutional oncologic database on 929 patients treated with RP by a single surgeon from 1999-2008. Spinal anesthesia was used for patients from 2002-2006. We compared outcomes of these patients (n = 264) with outcomes of patients who underwent general anesthesia (n = 665) at Memorial Sloan-Kettering Cancer Center from 1999-2001 and 2006-2008. Cox proportional hazards regression was used to assess differences in BCR rates between the anesthesia groups adjusting for differences in postoperative factors related to anesthetic technique and tumour pathologic characteristics associated with BCR after RP.

Results

Median follow-up among patients free from BCR was 4.6 yr. On multivariable analysis, spinal anesthesia did not independently predict the rate of BCR (hazard ratio = 1.10; 95% confidence interval 0.7 to 1.74; P = 0.7). Independent predictors of BCR were preoperative prostate-specific antigen (PSA), pathologic Gleason grade, extracapsular extension, and seminal vesicle invasion.

Conclusions

We did not find an association between anesthesia technique and disease recurrence in men with prostate cancer treated with RP. Anesthesia technique is unlikely to alter disease recurrence following RP independent of surgical and pathological factors.

Association entre techniques anesthésiques pour la prostatectomie radicale et récidive biochimique: une étude rétrospective de cohorte

Résumé

Introduction

La technique d’anesthésie a été associée aux aboutissements du traitement du cancer après prostatectomie radicale (PR). Ces études sont limitées par la variabilité de certains facteurs tels que l’expérience du chirurgien, les biais de sélections des patients et, dans certains cas, la taille de l’échantillon. Nous avons évalué l’impact de la technique d’anesthésie pour RP sur la récidive biochimique (RBC) à partir d’une grande cohorte de patients opérés par un seul et unique chirurgien expérimenté.

Méthodes

Nous avons réexaminé de façon rétrospective les données d’une base de données oncologiques institutionnelle portant sur 929 patients traités pour PR par un seul chirurgien entre 1999 et 2008. Une rachianesthésie a été utilisée pour les patients de 2002 à 2006. Nous avons comparé les résultats de ces patients (n = 264) avec les résultats de patients ayant bénéficié d’une anesthésie générale (n = 665) au Memorial Sloan-Kettering Cancer Center de 1999 à 2001 et de 2006 à 2008. Le modèle de régression des risques proportionnels de Cox a servi à évaluer les taux de RBC entre les groupes d’anesthésie avec un ajustement pour les différences entre les facteurs postopératoires liés à la technique anesthésique et les caractéristiques pathologiques de la tumeur associées à la RBC après PR.

Résultats

Le suivi médian pour les patients sans RBC a été de 4,6 ans. À l’analyse multivariée, la rachianesthésie n’a pas prédit de façon indépendante le taux de RBC (rapport de risque = 1,10; intervalle de confiance à 95 %: 0,7 à 1,74; P = 0,7). Les éléments prédictifs de RBC étaient le taux préopératoire de l’antigène spécifique de la prostate (PAS), le stade du score de Gleason, l’extension extracapsulaire et l’invasion des vésicules séminales.

Conclusions

Nous n’avons pas trouvé d’association entre la technique d’anesthésie et la récidive de la maladie chez les hommes atteints de cancer de la prostate et traités par PR. Il est peu probable que la technique d’anesthésie influence les récidives après PR, indépendamment des facteurs chirurgicaux et pathologiques.

Notes

Acknowledgements

The authors are grateful to Dr. Stephen Poon and Dr. Tatum Tarin for their support reviewing case records and patient data.

Funding

This study was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers.

Financial disclosures

None.

Conflicts of interest

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2014

Authors and Affiliations

  • Behfar Ehdaie
    • 1
    • 2
    • 3
  • Daniel D. Sjoberg
    • 3
  • Paul H. Dalecki
    • 1
    • 4
  • Peter T. Scardino
    • 1
    • 2
  • James A. Eastham
    • 1
    • 2
  • David Amar
    • 1
    • 4
  1. 1.Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Urology Service, Department of Surgery, Sidney Kimmel Center for Prostate and Urologic CancersMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of AnesthesiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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