Intraoperative use of dexmedetomidine is associated with decreased overall survival after lung cancer surgery.

BACKGROUND AND AIMS: The aim is to evaluate the association between the use of intraoperative dexmedetomidine with an increase in recurrence-free survival (RFS) and overall survival (OS) after nonsmall cell lung cancer (NSCLC) surgery. MATERIAL AND METHODS: This was a propensity score-matched (PSM) retrospective study. Single academic center. The study comprised patients with Stage I through IIIa NSCLC. Patients were excluded if they were younger than 18 years. Primary outcomes of the study were RFS and OS. RFS and OS were evaluated using univariate and multivariate Cox proportional hazards models after PSM (n = 251/group) to assess the association between intraoperative dexmedetomidine use and the primary outcomes. The value of P < 0.05 was considered statistically significant. RESULTS: After PSM and adjusting for significant covariates, the multivariate analysis demonstrated no association between the use of dexmedetomidine and RFS (hazard ratio [HR] [95% confidence interval (CI)]: HR = 1.18, 95% CI: 0.91-1.53; P = 0.199). The multivariate analysis also demonstrated an association between the administration of dexmedetomidine and reduced OS (HR = 1.28, 95% CI: 1.03-1.59; P = 0.024). CONCLUSIONS: This study demonstrated that the intraoperative use of dexmedetomidine to NSCLC patients was not associated with a significant impact on RFS and but worsening OS. A randomized controlled study should be conducted to confirm the results of this study.

Preoperative Echocardiographic Parameters of Diastolic Dysfunction Did Not Provide a Predictive Value for Postoperative Atrial Fibrillation in Lung and Esophageal Cancer Surgery.

OBJECTIVE: To evaluate the predictive value of preoperative transthoracic echocardiography in the development of postoperative atrial fibrillation after non-cardiac thoracic surgery. DESIGN: This was a retrospective study. SETTING: Academic hospital. PARTICIPANTS: A total of 703 adult patients with non-small cell lung cancer. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Retrospective data of 177 non-cardiac thoracic surgical oncologic patients undergoing lung or esophageal cancer surgery with preoperative transthoracic echocardiograms (TTE) (within 30 days before surgery) were analyzed. The Wilcoxon rank sum test was used to evaluate the difference in continuous variables. Fisher's exact test or the chi-square test was used to evaluate the association between two categoric variables. Logistic regression models were used for multivariate analysis to include important and significant covariates. Among the demographic and echocardiographic variables measured age, systemic hypertension, e` septal, e` lateral and E/e` ratio were significantly different between patients who would develop postoperative atrial fibrillation (POAF) and those who did not. The logistic regression models only identify age as a predictor factor of POAF. CONCLUSIONS: These results were similar to those published elsewhere on POAF incidence and risk factors. The preoperative echocardiographic variables in this study did not provide predictive value for POAF in non-cardiac thoracic surgery.

A retrospective analysis of the effect of intraoperative opioid dose on cancer recurrence after non-small cell lung cancer resection.

Preclinical studies have demonstrated that opioid receptor agonists increase the rate of non-small cell lung cancer (NSCLC) growth and metastasis. Following institutional review board approval, we retrieved data on 901 patients who underwent surgery for NSCLC at MD Anderson Cancer Center. Comprehensive demographics, intraoperative data, and recurrence-free survival (RFS) and overall survival (OS) at 3 and 5 years were obtained. Cox proportional analyses were conducted to assess the association between intraoperative opioid exposure and RFS and OS. The median intraoperative fentanyl equivalents dosage was 10.15 µg/kg. The multivariate analysis by stage indicated that a trend toward significance for opioid consumption as a risk factor in stage I patients (P = 0.053). No effect was found on RFS for stage II or III patients. Alternatively, opioid consumption was a risk factor for OS for stage I patients (P = 0.036), whereas no effect was noted for stage II or III patients. Intraoperative opioid use is associated with decreased OS in stage I but not stage II-III NSCLC patients. Until randomized controlled studies explore this association further, opioids should continue to be a key component of balanced anesthesia.