Background and Goal of Study: Recently published studies have suggested that the anaesthetic technique performed during oncological surgery impacts disease recurrence in prostate cancer. The objective of this study was to assess if, depending on the type of anaesthesia, a difference in disease progression and survival could be determined in a selected patients' population at high risk of cancer progression after open retropubic radical prostatectomy (RRP).
Materials and Methods: A consecutive series of 148 patients (65 patients with general anesthesia combined with epidural analgesia and 83 with general anesthesia with postoperative ketorolac-morphine analgesia) who underwent RRP between January 1994 and December 2000 were reviewed. Mean follow-up was 10.4 years (SD ± 4). Only patients with non-organ confined prostate cancer (pathological T3/4) were included. Baseline anaesthesiological and surgical data did not differ significantly between the two groups except the amount of fentanyl used (0.4mg ±0.2 vs 0.7mg ±0.2, P< 0.001). Biochemical recurrence-free (BCR), cancer-specific, and overall survival were estimated using the Kaplan-Meier technique. The multivariate Cox-proportional-hazards regression model included all relevant variables.
Results and Discussion: Kaplan-Meier survival estimates for BCR-free survival, cancer-specific survival and overall survival did not differ significantly between the 2 groups (Log-rank P=0.95, P=0.92 and P=0.84). In multivariate analysis preoperative PSA (HR 1.01, 95% CI 1.00-1.02, P< 0.0001), specimen Gleason scores >7 (HR 0.42, 95% CI 0.25-0.70, P=0.001), nodal stage (HR 0.61, 95% CI 0.39-0.94, P=0.02) and transfusion rate (HR 0.48, 95% CI 0.28-0.83, P=0.008) were associated with higher risk of biochemical recurrence. Significant negative predictors for cancer-specific survival were specimen Gleason scores 7 and > 7 (HR 0.33, 95%CI 0.04-0.26, P=0.001 and HR 0.39, 95% CI 0.18-0.85, P=0.04) and nodal state (HR 0.38, 95% CI 0.15-0.96, P=0.04). Significant predictors of negative outcome for overall survival were specimen Gleason scores 7 and > 7 (HR 0.18, 95% CI 0.07-0.49, P< 0.001 and HR 0.49, 95% CI 0.25-0.97, P=0.026) and nodal state (HR 0.47, 95% CI 0.23-0.95, P=0.0.37).
Conclusion(s): The hypothesis that general anaesthesia with epidural analgesia reduces the risk of cancer progression and/or improves survival in patients after RRP for prostate cancer could not be substantiated in this long term follow-up of more than 10 years.