Outcome at second-look laparotomy: Anaesthesia related risk factors

Purpose of investigation: To identify anaesthesia related risk factors associated with positive second-look laparotomy (SLL) findings in patients with epithelial ovarian carcinoma who had previous optimal cytoreduction surgery under general anaesthesia.

Methods: A retrospective review of the anaesthesia and medical records of patients with epithelial ovarian cancer who underwent SLL at our institution and analysis of patient related (age, haemoglobin, albumin), anaesthesia related (duration of anaesthesia, anaesthetics and dosages, transfusion of blood products), tumour related (stage, grade, presence of ascites, adhesion, histological type, capsule penetration and CA-125) data and outcome of SLL was undertaken.

Results: The patients had SLL 305 +/- 215 days after the first operation. Of the 83 patients 28 (33.7%) were SLL (+). SLL (+) patients were significantly more likely to have a mucinous histological subtype, required intraoperative packed red blood cell (PRBC) transfusion and longer anaesthesia duration (p < 0.05). Type of induction agent, whether narcotics were used or not, type of volatile agent used, dosages of induction agents and dosages of narcotic and muscle relaxants did not vary significantly between the patients with and without cancer recurrence (p > 0.05). Duration of anaesthesia (OR, 1.03; CI, 1-1.05, p = 0.031) and histological subtype (OR, 16.1; CI, 1.8-141.7, p = 0.012), were the independent variables predicting cancer recurrence in the multivariate logistic regression.

Conclusion: We emphasize that duration of anaesthesia and histological subtype are risk factors for cancer recurrence in early stage ovarian carcinoma. From our data it seems that interventions to shorten the duration of general anaesthesia or reversing immunosuppression induced by anaesthesia and surgery must be carefully considered.

Anaesthesia; Ovarian carcinoma; Recurrence; Immune Function; Multivariate analysis

[1] Bauer M., Rensing H., Ziegenfuss T.: "Anesthesia and penoperative immune function". Anaesthetist., 1998, 47 (7), 538.

[2] Tonessen E., Wahlgreen C.: "Influence of extradural or general anaesthesia on natural killer cell activity and lymphocyte subpopulations in-patients undergoing hysterectomy". Br. J. Anaesth., 1988, 60, 500.

[3] Crozier T.A., Miiller J.E., Quittkat D., Sydow M., Wuttke W., Kettler F.D.: "Effect of anaesthesia on the cytokine responses to abdominal surgery". Br. J. Anaesth., 1994, 72, 280.

[4] Moudgil G.C., Singal D.P.: "Halothane and isoflurane enhance melanoma tumour metastasis in mice". Can. J. Anaesth., 1997, 44, 90.

[5] Young R.C., Pecorelli S.: "Management of early ovarian cancer" Semin. Oneal., 1998, 25, 335.

[6] Friedlander M.L.: "Prognostic factors in ovarian cancer". Semzn. Oneal., 1998, 25, 305.

[7] Vanbelle S.J., Cocquyt V.: "Impact of haemoglobin levels on the outcome of cancers treated with chemotherapy". Crit. Rev. Oncol./Hematol., 2003, 47, 1.

[8] Obermair A., Petru E., Windbichler G. et al.: "Significance of pretreatment serum hemoglobin and survival in epithelial ovarian cancer". Oneal. Rep., 2000, 7, 639.

[9] Chen V.W., Ruiz B., Killen J.L., Cote T.R., Wu X.C., Correa C.N.: "Pathology and classification of ovarian tumors". Cancer, 2003, 97, 2631.

[10] Weese J.L., Ottery FD., Emoto S.E.: "Do operations facilitate tumor growth? An experimental model in rats". Surf?ery, 1986, 100, 273.

[11] Markovic S.N., Knight P.R., Murasko D.M.: "Inhibition of interferon stimulation of natural killer cell activity in mice anesthetized with halothane or isoflurane". Anesthesiology, 1993, 78, 700.

[12] Kutza J., Gratz I., Afshar M., Murasko D.M.:'The effects of general anesthesia and surgery on basal and interferon stimulated natural killer cell activity of humans". Anesth. Analg., 1997, 85, 918.

[13] Markovic S.N., Murasko D.M.: "Neoadjuvant immunotherapy with interferon of the spontaneously metastasizing murine B16F10L melanoma". Int. J. Cancer, 1990, 45, 788.

[14] Bookman M.A.: "Biological therapy of ovarian cancer". Semm Oncol., 1998, 25, 381.

[15] Ryhanen P., Jouppila R., lanning M., Jouppila P., Hollmen A.: "Natural killer cell activity after elective cesarean section under general and epidural anesthesia in healthy parturients and their newborns". Gynecol. Obstet. Invest., 1985, 19, 139.

[16] Helmy S.A.K., Al-Attiyah R.J.: 'The immunomodulatory effects of prolonged intravenous infusion of propofol versus midazolam in critically ill surgical patients". Anaesthesia, 2001, 56, 4.

[17] Beilin B., Shavit Y., Hart J., Mordashow B., Cohn S., Notti I.. Bessler H.: "Effects of anaesthesia based on large versus small doses of fentanyl on natural killer cell cytotoxicity in the perioperative period". Anesth. Analg., 1996, 82, 492.

[18] Blumberg N., Heal J.M.: "Murphy Perioperative blood transfusion and colorectal cancer recurrence". Transfusion, 1994, 34 (5), 450.

[19] Petranyl G.G., Reti M., Harsanyl V., Szabo J.: "Immunologic consequences of blood transfusion and their clinical manifestations" Int. Arch. Allergy Immunol., 1997, 114, 303.

[20] Vamvakas E., Moore S.B.: "Perioperative blood transfusion and colorectal cancer recurrence: a qualitative statistical overview and meta- analysis". Transfusion, 1993, 33, 754.

[21] Ishioka S., Sagae S., Terasawa K. et al.: "Comparison of usefulness between a new universal grading system for epithelial ovarian cancer and FIGO grading system". Gynecol. Oncol., 2003, 89, 447.