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Effect of Regional Anesthesia on Recurrence in Completely Resected, Stage IA Non-Small Cell Lung Cancer Patients
Sebastien Gilbert, Irfan Qureshi, Rodney J Landreneau, James D Luketich, Jacques E Chelly, Neil A Christie, Matthew J Schuchert
University of Pittsburgh Medical Center, Pittsburgh, PA
BACKGROUND:
Through its potential effect on the immune response to pain, regional anesthesia (RA) has been associated with decreased cancer recurrence in certain organ sites (e.g.: breast, melanoma). The study objective was to examine the relationship between RA and recurrence in lung cancer patients.
METHODS:
Retrospective review of completely resected, stage IA, non-small cell lung cancer (NSCLC) patients. Patients were divided in 2 groups: RA and patient-controlled intravenous analgesia alone (PCA). The relationship between RA and oncologic outcomes was evaluated using a multivariate analysis.
RESULTS:
From 2001-2006, 165 patients (male=53.3%; female=46.7%; age= 67.6 ± 0.7 years) had complete resection for stage IA NSCLC, and none received chemotherapy or radiation. Regional anesthesia (RA) was utilized in 91 (55.2%) and patient-controlled intravenous analgesia (PCA) in 74 (44.8%). Sublobar resection was performed in 48 (29.1%). The groups were statistically similar in gender, histology, type of resection (sublobar versus lobar), mean tumor size, proportion of tumors > 2 cm, and overall survival. Recurrences were locoregional in 11 (6.7%) and distant in 24 (14.5%). The overall mean recurrence-free interval was 37.7 ± 1.5 months. Although the distant recurrence rate was similar, the probability of locoregional recurrence was significantly lower in patients who received RA (0.6% vs 6.1%; p=0.006). The mean recurrence-free interval was significantly longer (8.2 months) in the RA group (76.6 ± 0.8 vs 68.4 ± 2.6 months; p=0.011). After multivariate analysis, RA remained a significant predictor of improved locoregional recurrence rate (p=0.014).
CONCLUSIONS:
In lung cancer patients who undergo surgical resection, the potential impact of perioperative pain control strategies on cancer recurrence merits further investigation. 
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