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Anaesthetic modality and post-surgical oncological outcomes for paediatric tumours: is there a link?
Shu Ying Lee1, Sanchalika Acharyya2, Ashley Wan Ling Tan3
1Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Insights
Epidural anesthesia in children with solid tumors showed no significant impact on relapse-free survival overall. However, a clinically meaningful reduction in relapse risk was observed in pediatric sarcoma patients receiving epidural anesthesia.
Area of Science:
- Pediatric Oncology
- Anesthesiology
- Surgical Oncology
Background:
- Solid tumors in children often require surgery, with a risk of micrometastasis.
- Neuraxial anesthesia's potential to modulate the immune response against metastasis is supported by preclinical data.
- Existing human studies in adults show mixed results, and pediatric data is lacking.
Purpose of the Study:
- To investigate the association between intraoperative epidural anesthesia, opioid, and volatile anesthetic dose with relapse-free survival (RFS) in pediatric solid tumor patients.
- To address the gap in pediatric research regarding anesthesia techniques and cancer recurrence.
Main Methods:
- Retrospective cohort study of 126 children with solid tumors (neuroblastoma, hepatoblastoma, sarcoma) over 16 years.
- Relapse-free survival (RFS) estimated using Kaplan-Meier method and stratified by tumor subtype.
- Multivariable Cox regression models used to calculate adjusted hazard ratios (aHRs).
Main Results:
- 53.2% of patients received combined general anesthesia (GA)/epidural.
- Relapse rates were 31.3% in the epidural group and 33.9% in the GA alone group.
- Pediatric sarcoma patients receiving combined GA/epidural showed a trend towards lower relapse risk (aHR 0.51), though not statistically significant.
Conclusions:
- No statistically significant association was found between epidural use and improved RFS in pediatric solid tumor patients overall.
- A clinically meaningful association was observed in pediatric sarcoma patients, suggesting potential benefits.
- Further research may be warranted to explore specific subgroups and anesthetic techniques.
Introduction:
Children with solid organ tumours often present for curative surgery. Even with the best surgical technique, micrometastases can occur. Preclinical studies support the postulation that neuraxial anaesthesia maintains the body's immune and inflammatory milieu against metastasis. However, human retrospective adult studies showed varying results, and no study has been done in children. We aimed to find out if intraoperative epidural, perioperative opioid and volatile dose are associated with relapse-free survival (RFS) in children with solid organ tumours.
Methods:
This is a retrospective cohort study of 126 children from a tertiary paediatric unit who were diagnosed with solid organ tumours (neuroblastoma, hepatoblastoma or sarcoma) over a 16-year period. RFS, stratified by tumour subtypes, was estimated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) were obtained from multivariable Cox regression models after taking potential covariates into account.
Results:
Of 126 children with solid organ tumours (51.6% neuroblastoma, 34.9% sarcoma and 13.5% hepatoblastoma), 53.2% received combined general anaesthesia (GA)/epidural. A total of 21 (31.3%) and 20 (33.9%) patients relapsed during the study period in the combined GA/epidural group and the GA alone group, respectively. Patients with sarcoma receiving combined GA/epidural had a clinically meaningful lower risk of relapse compared to patients receiving GA alone (aHR 0.51, 95% confidence interval 0.14-1.79), although this was not statistically significant.
Conclusion:
Our study demonstrated some clinically meaningful associations, especially in paediatric sarcoma patients. Overall, however, there was no statistically significant association between epidural use and an improved RFS.
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