Breast cancer recurrence after regional vs. general anesthesia
Trial question
What is the role of regional anesthesia-analgesia in breast cancer recurrence after potentially curative surgery?
Study design
Multi-center
Open label
RCT
Population
2132 female patients.
Inclusion criteria: women aged < 85 years having potentially curative primary breast cancer resections.
Key exclusion criteria: previous surgery for breast cancer (except diagnostic biopsies), inflammatory breast cancer, scheduled free-flap reconstruction, contraindications to either anesthetic approach or analgesic, or other cancer not in long-term remission.
Interventions
N=1043 regional anesthesia-analgesia (paravertebral blocks and propofol).
N=1065 general anesthesia (sevoflurane and opioid analgesia).
Primary outcome
Local or metastatic breast cancer recurrence
10%
10%
10.0 %
7.5 %
5.0 %
2.5 %
0.0 %
Regional
anesthesia-analgesia
General
anesthesia
No significant
difference ↔
No significant difference in local or metastatic breast cancer recurrence (10% vs. 10%; HR 0.97, 95% CI 0.74 to 1.28).
Secondary outcomes
No significant difference in incisional pain at 6 months and 12 months (52% vs. 52%; aOR 1, 95% CI 0.85 to 1.17).
Safety outcomes
No significant differences in QoL as assessed by scores on SF-12, death.
Significant difference in postoperative nausea (8% vs. 20%).
Conclusion
In women aged < 85 years having potentially curative primary breast cancer resections, regional anesthesia-analgesia was not superior to general anesthesia with respect to local or metastatic breast cancer recurrence.
Reference
Daniel I Sessler, Lijian Pei, Yuguang Huang et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet. 2019 Nov 16;394(10211):1807-1815.
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