A study presented at this year’s American Society of Anesthesiologists Annual Meeting offers evidence that patients with malignant melanoma who undergo inguinal lymph node dissection with spinal anesthesia (a regional anesthetic) have a better prognosis than patients who undergo the same surgery with general anesthesia.
Malignant melanoma is the deadliest form of skin cancer because of its risk for spreading. Treatment often consists of sentinel or radical lymph node dissection. Such dissection involves surgical stress, anesthetics and opioids, all of which can depress one’s immune system and increase the risk of tumor spread, recurrence and death.
"While cancer patients need an operation to remove or reduce tumor cells, the anesthesia used can cause other complications," said the study’s lead author, Gerhard Brodner, Professor Dr. Dr., Fachklinik Hornheide, Germany. "It is important to determine whether a specific type of anesthesia can have a better impact on melanoma patients’ survival rate."
About the Study
In this retrospective study, researchers examined the medical records of 273 patients who underwent inguinal lymph node dissection (sentinel or radical) after primary malignant melanoma of the leg either with regional or general anesthesia between 1998 and 2005. A total of 52 patients received spinal anesthesia, while the remaining 221 patients received general anesthesia.
Results showed a significant effect on the cumulative survival rates over 10 years after surgery for several predictors, including gender, perioperative risk classification of the American Society of Anesthesiologists, tumor size and type of surgery.
After adjustment for these predictors, statistical analysis demonstrated a tendency toward a significantly better cumulative survival rate over 10 years after spinal anesthesia compared to general anesthesia. The mean survival time for patients who received spinal anesthesia was 95.9 months, whereas the survival time for patients who received general anesthesia was 70.4 months.
"These findings suggest that regional anesthesia prolongs the survival rate for melanoma patients better than general anesthesia," concluded Dr. Brodner. "While surgery and anesthesia are known to be a double-edged sword for malignant melanoma patients, this research, along with future research, can help reduce the risk these patients face during lymph node dissection."
Dr. Brodner’s research group is currently conducting a randomized trial to confirm this study’s hypothesis and findings.