Background: An increased intraoperative opioid dose seems to lead to worse outcomes in several types of cancer. We assessed the effect of intraoperatively administered opioids as well as the type of anesthesia on survival, recurrence rates and major perioperative outcomes in patients who underwent radical cystectomy (RC) for urothelial carcinoma of the urinary bladder. Methods: We included patients who underwent open RC at our center between 2015 and 2022. The role of the type and dosage of intraoperative opioid agents, such as remifentanil, sufentanil and morphine milligram equivalents (MME), as well as the type of anesthesia (intravenous only versus intravenous/epidural), was assessed regarding perioperative and long-term outcomes after RC. Results: A total of 508 patients with a median age of 73 years (IQR: 64–78) were included. Overall, 92 (18%) patients received intravenous anesthesia, whereas 416 (82%) received combined anesthesia. At a median follow-up of 270 days (IQR: 98–808), 108 (21%) deaths and 106 (21%) recurrences occurred. Combined anesthesia was associated with better survival (HR:0.63, 95% CI: 0.4–0.97,p= 0.037) and lower intensive care unit admission rates (OR: 0.49, 95% CI: 0.31–0.77,p= 0.002) in the univariate analysis (unadjusted). The type and dosage of intraoperative opioid agents did not affect long-term survival and recurrence rates, as well as major perioperative outcomes. Nevertheless, the findings of our study were limited by its single-center, retrospective design. Conclusion: The use of intraoperative opioids was not associated with worse outcomes in our cohort, while the use of additional epidural anesthesia seems to be beneficial in terms of overall survival and intensive care unit admissions. Nevertheless, further research is mandatory to validate the safety of opioids in patients undergoing RC.
背景：术中阿片类药物剂量增加似乎与多种癌症的不良预后相关。本研究评估了接受根治性膀胱切除术（RC）治疗膀胱尿路上皮癌患者术中阿片类药物使用及麻醉方式对生存率、复发率和主要围手术期结局的影响。方法：纳入2015年至2022年间在本中心接受开放RC的患者。评估术中阿片类药物（如瑞芬太尼、舒芬太尼及吗啡毫克当量[MME]）的类型与剂量，以及麻醉方式（单纯静脉麻醉与静脉/硬膜外联合麻醉）对RC术后围手术期及长期结局的影响。结果：共纳入508例患者，中位年龄73岁（四分位距：64-78岁）。其中92例（18%）接受静脉麻醉，416例（82%）接受联合麻醉。中位随访270天（四分位距：98-808天）期间，共发生108例（21%）死亡和106例（21%）复发。单因素分析（未校正）显示，联合麻醉与更好的生存率（风险比：0.63，95%置信区间：0.4-0.97，p=0.037）及更低的重症监护室入住率（比值比：0.49，95%置信区间：0.31-0.77，p=0.002）相关。术中阿片类药物的类型与剂量对长期生存率、复发率及主要围手术期结局均无显著影响。然而，本研究的单中心回顾性设计存在局限性。结论：在本研究队列中，术中阿片类药物的使用与不良结局无关，而联合硬膜外麻醉在总生存率和重症监护室入住率方面显示出优势。但需进一步研究以验证RC患者使用阿片类药物的安全性。
肿瘤(癌症)患者之家