Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma?

Br J Anaesth. 2012 Aug;109(2):253-9. doi: 10.1093/bja/aes176. Epub 2012 Jun 15.

Abstract

Background: Optimized anaesthetic management might improve the outcome after cancer surgery. A retrospective analysis was performed to assess the association between spinal anaesthesia (SpA) or general anaesthesia (GA) and survival in patients undergoing surgery for malignant melanoma (MM).

Methods: Records for 275 patients who required SpA or GA for inguinal lymph-node dissection after primary MM in the lower extremity between 1998 and 2005 were reviewed. The follow-up ended in 2009. Survival was calculated as days from surgery to the date of death or last patient contact. The primary endpoint was mortality during a 10 yr observation period.

Results: Of 273 patients included, 52 received SpA and 221 GA, either as balanced anaesthesia (sevoflurane/sufentanil, n=118) or as total i.v. anaesthesia (propofol/remifentanil, n=103). The mean follow-up period was 52.2 (sd 35.69) months after operation. Significant effects on cumulative survival were observed for gender, ASA status, tumour size, and type of surgery (P=0.000). After matched-pairs adjustment, no differences in these variables were found between patients with SpA and GA. A trend towards a better cumulative survival rate for patients with SpA was demonstrated [mean survival (months), SpA: 95.9, 95% confidence interval (CI), 81.2-110.5; GA: 70.4, 95% CI, 53.6-87.1; P=0.087]. Further analysis comparing SpA with the subgroup of balanced volatile GA confirmed this trend [mean survival (months), SpA: 95.9, 95% CI, 81.2-110.5; volatile balanced anaesthesia: 68.5, 95% CI, 49.6-87.5, P=0.081].

Conclusions: These data suggest an association between anaesthetic technique and cancer outcome in MM patients after lymph-node dissection. Prospective controlled trials on this topic are warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, General / methods
  • Anesthesia, Spinal / methods*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Node Excision / methods*
  • Lymphatic Metastasis
  • Male
  • Melanoma / pathology
  • Melanoma / secondary*
  • Melanoma / surgery*
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Skin Neoplasms / pathology*
  • Treatment Outcome
  • Young Adult