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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."

The Scan

Drug Response Variants May Be Distinct in Somatic, Germline Samples

Based on variants from across 21 drug response genes, researchers in The Pharmacogenomics Journal suspect that tumor-only DNA sequences may miss drug response clues found in the germline.

Breast Cancer Risk Gene Candidates Found by Multi-Ancestry Low-Frequency Variant Analysis

Researchers narrowed in on new and known risk gene candidates with variant profiles for almost 83,500 individuals with breast cancer and 59,199 unaffected controls in Genome Medicine.

Health-Related Quality of Life Gets Boost After Microbiome-Based Treatment for Recurrent C. Diff

A secondary analysis of Phase 3 clinical trial data in JAMA Network Open suggests an investigational oral microbiome-based drug may lead to enhanced quality of life measures.

Study Follows Consequences of Early Confirmatory Trials for Accelerated Approval Indications

Time to traditional approval or withdrawal was shorter when confirmatory trials started prior to accelerated approval, though overall regulatory outcomes remained similar, a JAMA study finds.