Post-Surgery Painkillers May Affect Prostate Cancer Outcomes
According to new research, opioid painkillers commonly administered during and after surgery to remove prostate glands may suppress the immune system’s ability to fight cancer cells.
A study led by Mayo Clinic researchers found the methods used to anesthetize prostate cancer patients and control their pain when having the prostate glands removed for adenocarcinoma may affect patients’ long-term cancer outcomes.
The findings suggest that supplementing general anesthesia with a spinal or epidural painkiller before a radical prostatectomy diminishes the patient’s need for opioids after surgery, according to the study authors, who associated this finding with a lower risk of cancer recurrence. Researchers tested the hypotheses that the combination of general and neuraxial analgesia reduces adverse oncological outcomes in patients having radical prostatectomy for adenocarcinoma, says Juraj Sprung, MD, PhD, professor of anesthesiology at the college of medicine at Mayo Clinic and co-author of the study.
Sprung notes the Mayo report joins several prior studies that have examined the role of the type of anesthesia and the opioid-sparing effect of neuraxial analgesia on oncological outcomes. “We found that when opioid painkiller use is reduced during and after surgery, some aspects of oncological outcome improve,” says Sprung, adding that “it is too early to give a definitive message on what should be a mainstay of perioperative anesthetic management for these patients.” The study does, however, provide a signal that “the choice of anesthesia may play a role on long-term outcomes in some types of tumors,” he says, stressing that a definitive answer will need to await the results from additional trials. “Cancer treatments remain complex, and the mainstay of treatment is early detection, surgical removal of the tumor when possible, chemotherapy, radiation therapy, and immunotherapy, when applicable,” says Sprung. “Our study gives an additional modality and hope that management of perioperative pain with spinal anesthesia, which at minimum gives better perioperative comfort, may be associated with a lower rate of tumor recurrence and therefore may contribute to better outcomes in these patients.”
The study findings originally appeared in the British Journal of Anaesthesia.
Scavonetto F, Yeoh T, et al. Association between neuraxial analgesia, cancer progression, and mortality after radical prostatectomy: a large, retrospective matched cohort study. British Journal of Anaesthesia. 2013.