Anaesthetic techniques for risk of malignant tumour recurrence.

摘要: Background Surgery remains a mainstay of treatment for malignant tumours; however, surgical manipulation leads to significant systemic release tumour cells. Whether these cells lead metastases is largely dependent on the balance between aggressiveness and resilience body. Surgical stress per se, anaesthetic agents administration opioid analgesics perioperatively can compromise immune function might shift towards progression minimal residual disease. Regional anaesthesia techniques provide perioperative pain relief; they therefore reduce quantity opioids used. Additionally, regional are known prevent or attenuate response. In recent years, potential benefit recurrence has received major attention been discussed many times in literature. preparing this review, we aimed summarize current evidence systematically comprehensively. Objectives To establish whether technique (general versus combination two techniques) influences long-term prognosis individuals with tumours. Search methods We searched The Cochrane Library (2013, Issue 12), PubMed (1950 15 December 2013), EMBASE (1974 BIOSIS (1926 2013) Web Science (1965 2013). We handsearched relevant websites conference proceedings reference lists cited articles. applied no language restrictions. Selection criteria We included all randomized controlled trials clinical that investigated effects general risk patients undergoing resection primary tumours. Comparisons interventions consisted (1) alone combined one more techniques; (2) (3) techniques. Primary outcomes overall survival, progression-free survival time progression. Data collection analysis Two review authors independently scanned titles abstracts identified reports extracted study data. All outcome variables time-to-event data. If individual trial report provided summary statistics odds ratios, relative risks Kaplan-Meier curves, data enabled us calculate hazard ratio using calculating spreadsheet. To assess bias, used standard methodological procedures expected by Collaboration. Main results We four studies total 746 participants. All adult surgery resection. Two enrolled male female participants abdominal cancer. One prostate cancer, colon Follow-up ranged from nine 17 years. compared epidural analgesia. secondary analyses previously conducted prospective trials. Of studies, only three contributed each progression. our meta-analysis, could not find an advantage either group (hazard (HR) 1.03, 95% confidence interval (CI) 0.86 1.24) (HR 0.88, CI 0.56 1.38). For level inconsistency was high. Pooled showed slightly favourable control alone) intervention (epidural anaesthesia) 1.50, 1.00 2.25). Quality graded low very downgraded serious imprecision indirectness. were also respectively. Reporting adverse events sparse, be analysed. Authors' conclusions Currently, inadequate. An encouraging number ongoing, it hoped their results, when reported, will add topic near future.