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This Week in the British Medical Journal: Apr 4, 2011

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In the British Medical Journal this week, researchers in Australia and the US present findings from a randomized trial comparing long-term recurrence of cancer and survival of patients having major abdominal surgery for cancer. The researchers followed patients who were randomly assigned to receive general anesthesia with or without an epidural block for at least three days post-surgery. Recurrence-free survival was similar in both epidural and control groups, the researchers write, leading to the conclusion that the use of epidural block in abdominal cancer surgery is not associated with improved cancer-free survival.

Also in the British Medical Journal this week, the University of Alberta's BCH Tsui and JS Green say in an editorial that while regional anesthesia has short-term benefits over general anesthesia, the cancer-related effects are unknown. The immune system plays a role in regulating tumor growth and metastasis, and the immunosuppressive effects of anesthesia have been hypothesized to promote cancer recurrence after resection of certain types of the disease, the authors write. Anesthesia that promotes the immune system has been suggested to reduce cancer recurrence. Recent studies have shown conflicting results, however. "The use of regional anesthesia could possibly have a clinical effect that might require regional anesthesia to be used as a stand alone technique," Tsui and Green write. "Oncological benefit could be limited to a subgroup of patients with cancer presenting at certain stages or grades of cancer for resection. If even a small difference in outcome is associated with regional techniques, the clinical impact could be significant given the large numbers of patients affected by common malignancies such as breast cancer."

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