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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Neuraxial Anesthesia and Cancer Recurrence Following Prostatectomy: Thinking Outside the Box.

Maria P Ntalouka1, Panagiotis J Vlachostergios2,3,4, Metaxia Bareka1

  • 1Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece.

Pharmacy (Basel, Switzerland)
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Summary

Neuraxial anesthesia may improve survival after prostatectomy for prostate cancer (PC) compared to general anesthesia, particularly for patients with comorbidities. Further research is needed to clarify its impact on cancer recurrence and long-term outcomes.

Keywords:
cancer recurrenceneuraxial anesthesiaoverall survivalperioperative careradical prostatectomyregional anesthesia

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Area of Science:

  • Oncology and Anesthesiology
  • Surgical Oncology
  • Perioperative Medicine

Background:

  • Radical prostatectomy (RP) is a standard treatment for localized prostate cancer (PC).
  • Perioperative factors, including anesthesia type, may influence PC prognosis by promoting a tumor-propagating state.
  • Mechanisms include sympathetic activation, increased opioid use, and inflammation.

Purpose of the Study:

  • To review the impact of the perioperative period on PC prognosis and patient outcomes.
  • To investigate the association between neuraxial anesthesia and outcomes following RP for PC.

Main Methods:

  • A non-systematic literature review was conducted.
  • Keywords included: "cancer recurrence" OR "cancer prognosis" OR "metastasis" AND "neuraxial anesthesia" AND "prostate cancer".
  • Eligible studies were summarized in a narrative review format.

Main Results:

  • Neuraxial anesthesia was associated with reduced mortality after RP compared to general anesthesia, especially in the era of limited ERAS protocols.
  • No significant association was found between anesthetic technique and cancer recurrence-free survival (radiological or biochemical).
  • Regional anesthesia may benefit short-term survival in patients with severe comorbidities, potentially reducing pulmonary complications and thrombosis.

Conclusions:

  • The effect of anesthetic technique on PC patient outcomes requires further investigation, as current evidence is preliminary and largely retrospective.
  • Preliminary evidence suggests a potential positive impact of neuraxial anesthesia on patient outcomes.
  • The collaboration between surgeons and onco-anesthesiologists is critical during the vulnerable perioperative period.