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  • Spinal Anesthesia Does Not Impact Prostate Cancer Recurrence in a Cohort of Men Undergoing Radical Prostatectomy: An Observational Study

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Spinal Anesthesia Does Not Impact Prostate Cancer Recurrence in a Cohort of Men Undergoing Radical Prostatectomy: An Observational Study
  1. Kenneth S. Tseng, MD*,
  2. Sachin Kulkarni, MD†,
  3. Elizabeth B. Humphreys, BS‡,
  4. H. Ballentine Carter, MD‡,
  5. Jacek L. Mostwin, MD, DPhil (Oxon.)‡,
  6. Alan W. Partin, MD, PhD‡,
  7. Misop Han, MD‡ and
  8. Christopher L. Wu, MD†
  1. *Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY
  2. †Department of Anesthesiology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD
  3. ‡Department of Urology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, MD
  1. Address correspondence to: Christopher L. Wu, MD, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Sheikh Zayed Tower 8120J, 1800 Orleans St, Baltimore, MD 21287 (e-mail: cwu3{at}jhmi.edu).

Abstract

Background and Objectives Prior studies suggest a possible association between the use of neuraxial-general anesthesia and a decrease in prostate cancer recurrence after radical prostatectomy. We examine the correlation of a spinal anesthesia–only technique on prostate cancer recurrence.

Methods Charts from consecutive radical prostatectomy patients of 3 experienced urologists from January 1999 to December 2005 were reviewed. In addition to the usual clinical and pathologic predictors of disease recurrence, patient records were queried for the type of anesthesia (general vs spinal) performed. A Cox proportional hazards model was used to determine the statistical significance of predictors of biochemical recurrence.

Results A total of 1964 patients—1166 and 798 receiving spinal with sedation or general anesthesia, respectively—had complete preoperative and follow-up data. In univariate proportional hazards analysis, the use of general anesthesia was associated with a trend toward an increased risk of biochemical recurrence when compared with the use of spinal anesthesia (hazard ratio, 1.29; 95% confidence interval, 0.99–1.66; P = 0.053). In multivariable analysis, the effect size (hazard ratio, 1.10; 95% confidence interval, 0.85–1.42; P = 0.458) was diminished by clinical and pathologic variables.

Conclusions This was a retrospective study of patients with prostate cancer who have undergone radical prostatectomy during a time period when the practice of anesthesia for prostatectomy at our institution was transitioned from spinal to general anesthesia. In our study, when controlling for other predictors of advanced prostate cancer, the type of anesthetic given during prostatectomy had no effect on the risk of biochemical recurrence.

https://doi.org/10.1097/AAP.0000000000000108

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    Footnotes

    • The authors declare no conflict of interest.

      This work received support from NIH SPORE grant P50CA58236 and from the Departments of Anesthesiology and Critical Care Medicine and Urology, The Johns Hopkins University School of Medicine.

      This report was previously presented, in part, at the 38th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, May 3, 2013, Boston, MA; and the New York Academy of Medicine Anesthesiology Residents’ Night, October 25, 2013, New York, NY.