Intra-operative norepinephrine administration and cancer-related outcomes following radical cystectomy for bladder cancer: A cohort study.

Löffel, Lukas M.; Furrer, Marc A.; Favre, Aline; Engel, Dominique; Gahl, Brigitta; Burkhard, Fiona C.; Wuethrich, Patrick Y. (2020). Intra-operative norepinephrine administration and cancer-related outcomes following radical cystectomy for bladder cancer: A cohort study. European journal of anaesthesiology, 37(5), pp. 377-386. Lippincott Williams & Wilkins 10.1097/EJA.0000000000001155

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BACKGROUND

The impact of anaesthetic techniques on recurrence of cancers is controversial. Elevated plasma catecholamine levels have been implicated in angiogenesis and metastasis in various cancers.

OBJECTIVES

To assess the potential association between continuous intra-operative norepinephrine administration and tumour-related outcome in muscle-invasive bladder cancer patients undergoing radical cystectomy with urinary diversion.

DESIGN

Retrospective observational cohort study.

SETTING

Single tertiary centre, from 2000 to 2017.

PATIENTS

We included a consecutive series of 1120 urothelial carcinoma patients undergoing radical cystectomy and urinary diversion, including 411/1120 patients (37%) who received a continuous intra-operative administration of more than 2 μg kg BW h norepinephrine.

MAIN OUTCOME MEASURES

The primary outcome was time to tumour recurrence within 5 years after surgery, with death as competing outcome. We used inverse probability of treatment weighting to adjust for imbalances between treatment groups, one having received more than 2 μg kg BW h norepinephrine and the other having received less. We furthermore adjusted for intra-operative variables or years of surgery as sensitivity analyses.

RESULTS

The continuous administration of more than 2 μg kg BW h norepinephrine slightly increased tumour recurrence (hazard ratio: 1.47, 95% CI 0.98 to 2.21; P = 0.061). After adjustment for intra-operative variables, and year of surgery hazard ratios were 1.82 (95% CI 1.13 to 2.91, P = 0.013) and 1.85 (95% CI 1.12 to 3.07, P = 0.017), respectively. Overall mortality (with or without tumour recurrence) was not affected by norepinephrine (hazard ratio: 0.84, 95% CI 0.65 to 1.08, P = 0.170).

CONCLUSION

Continuous administration of more than 2 μg kg BW h norepinephrine was associated with a slightly increased hazard ratio for tumour recurrence if adjusted for intra-operative variables and year of surgery. This observation could reflect a low potential pro-oncogenic effect of norepinephrine during the intra-operative period.

TRIAL REGISTRATION

Not applicable.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Löffel, Lukas; Furrer, Marc; Engel, Dominique; Gahl, Brigitta; Burkhard, Fiona and Wüthrich, Patrick Yves

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0265-0215

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannine Wiemann

Date Deposited:

16 Mar 2020 12:47

Last Modified:

05 Jan 2021 13:01

Publisher DOI:

10.1097/EJA.0000000000001155

PubMed ID:

31977630

Additional Information:

Löffel and Furrer contributed equally to this work.

BORIS DOI:

10.7892/boris.141107

URI:

https://boris.unibe.ch/id/eprint/141107

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