Initial management approach for localized/locally advanced disease is critical to guide metastatic castration-resistant prostate cancer care.

BACKGROUND: Currently, several therapies are available for metastatic castration-resistant prostate cancer (mCRPC) but no specific clinical factors to personalize treatment. We first sought the prognostic value of duration on androgen-deprivation therapy (ADT) for hormone-sensitive prostate cancer (HSPC) in patients receiving androgen-receptor-signaling inhibitors (ARSI) for mCRPC. METHODS: A multicenter cohort of mCRPC patients who started ARSI between July 2011 and October 2021 was identified. Based on their initial disease burden and duration on ADT for HSPC, primary progressive (PP) men were classified into four groups: low/intermediate-risk localized disease (LOC) and high-risk localized/locally advanced disease (LAD) and short-term (ST) < 24 vs. long-term (LT) ADT ≥ 24 months, whereas de novo (DN) mHSPC were subdivided into short-time vs. long-time to CRPC. RESULTS: We included 919 mCRPC patients with a median age of 77 years [interquartile range (IQR) = 71-82)]. Median ADT duration in HSPC was 24 months (IQR = 14-40). Median follow-up was 91 months (IQR = 62-138), median OS and PFS from ARSI start were 20 (IQR 10-32) and 10 months (IQR = 5-19), respectively. In PP developing metastatic disease (n = 655, 71.3%), LOC and LAD with ST ADT had a greater than almost double-risk of death compared to LT ADT (LOC/ST: hazard ratio [HR] = 2.01; 95% CI 1.54-2.64; LAD/ST: HR = 1.73; 95% CI 1.34-2.24; p < 0.001). In the multivariate analysis including age, prognostic cohort, Gleason, ECOG, radical radiotherapy and prostatectomy, groups with ST ADT were associated with worse OS compared to LT ADT (LOC/ST: HR = 1.84; 95% CI 1.38-2.45; p < 0.001; LAD/ST: HR = 1.59; 95% CI 1.21-2.10; p < 0.001), along with ECOG > 2 (HR = 1.55; 95% CI 1.06-2.26; p = 0.03). There were also similar results of PFS. Moreover, long-time to CRPC in patients with history of DN mHSPC (n = 264, 28.7%) resulted in a better OS/PFS (HR = 0.76, 95% CI 0.56-1.02, p = 0.064 and HR = 0.74, 95% CI 0.55-0.99, p = 0.042, respectively). CONCLUSIONS: Our study showed that duration on ADT for mHSPC was significantly associated with survival in mCRPC undergoing ARSI. These findings suggest a possible connection between initial management of prostate tumour and a better prognostication in mCRPC. Prospective trials are warranted.

Pancreatic Enzyme Replacement and Nutritional Support With nab-Paclitaxel-based First-Line Chemotherapy Regimens in Metastatic Pancreatic Cancer.

BACKGROUND: At diagnosis, more than 80% of patients with pancreatic cancer (PC) suffer from significant weight loss due to malnutrition which is a major concern for patient management, and this may negatively impact treatment outcomes and patient prognosis. PATIENTS AND METHODS: We performed an observational, retrospective study on patients with metastatic PC (mPC) undergoing first-line chemotherapy with nab-Paclitaxel containing schedules and receiving or not receiving nutritional support (NS) and pancreatic enzyme replacement therapy (PERT) to investigate their relevance in this setting. RESULTS: We observed that PERT and ancillary dietary interventions are related to longer overall survival (OS; median: 16.5 vs. 7.5 months, P < .001) and have a significant, independent, prognostic impact for better outcomes (P = .013), independently from the therapeutic regimen. Furthermore, PERT and NS prevented weight loss during chemotherapy and obtained an improvement of nutritional parameters such as phase angle and free-fat mass index, after 3 months of anticancer treatment. Consistently, the positive impact on OS correlated also with the prevention of Karnofsky performance status deterioration and a lower incidence of maldigestion-related symptoms. CONCLUSIONS: Our data suggest that an early and well-conducted NS in patients with mPC may impact on survival and preserve performance status, thus improving quality of life.

Differential and divergent activity of insulin-like growth factor binding protein 6 in platinum-sensitive versus platinum-resistant high-grade serous ovarian carcinoma cell lines.

Insulin-like growth factor binding protein 6 (IGFBP6) is a secreted protein with a controversial role in human malignancies, being downregulated in most types of human cancer, but upregulated in selected tumors. Ovarian cancer (OC) is a human malignancy characterized by IGFBP6 downregulation; however, the significance of its low expression during ovarian carcinogenesis is still poorly understood. In the present study, IGFBP6 expression and activation of its associated signaling pathway were evaluated in two matched OC cell lines derived from a high-grade serous OC before and after platinum resistance (PEA1 and PEA2 cells, respectively). A whole genome gene expression analysis was comparatively performed in both cell lines upon IGFBP6 stimulation using Illumina technology. IGFBP6 gene expression data from human OC cases were obtained from public datasets. Gene expression data from public datasets confirmed the downregulation of IGFBP6 in primary and metastatic OC tissues compared with in normal ovarian tissues. The comparative analysis of platinum-sensitive (PEA1) and platinum-resistant (PEA2) cell lines showed quantitative and qualitative differences in the activation of IGFBP6 signaling. Notably, IGFBP6 enhanced ERK1/2 phosphorylation only in PEA1 cells, and induced more evident and significant gene expression reprogramming in PEA1 cells compared with in PEA2 cells. Furthermore, the analysis of selected genes modulated by IGFBP6 (i.e., FOS, JUN, TNF, IL6, IL8 and EGR1) exhibited an inverse regulation in PEA1 versus PEA2 cells. In addition, selected hallmarks (TNFA_signaling_via_NFKB, TGF_beta_signaling, P53_pathway) and IL-6 signaling were positively regulated in PEA1 cells, whereas they were inhibited in PEA2 cells in response to IGFBP6. These data suggested that dysregulation of IGFBP6 signaling may serve a role in the progression of OC, and is likely associated with the development of platinum resistance.

TRAP1 regulates the response of colorectal cancer cells to hypoxia and inhibits ribosome biogenesis under conditions of oxygen deprivation.

Metabolic rewiring fuels rapid cancer cell proliferation by promoting adjustments in energetic resources, and increasing glucose uptake and its conversion into lactate, even in the presence of oxygen. Furthermore, solid tumors often contain hypoxic areas and can rapidly adapt to low oxygen conditions by activating hypoxia inducible factor (HIF)­1α and several downstream pathways, thus sustaining cell survival and metabolic reprogramming. Since TNF receptor­associated protein 1 (TRAP1) is a HSP90 molecular chaperone upregulated in several human malignancies and is involved in cancer cell adaptation to unfavorable environments and metabolic reprogramming, in the present study, its role was investigated in the adaptive response to hypoxia in human colorectal cancer (CRC) cells and organoids. In the present study, glucose uptake, lactate production and the expression of key metabolic genes were evaluated in TRAP1­silenced CRC cell models under conditions of hypoxia/normoxia. Whole genome gene expression profiling was performed in TRAP1­silenced HCT116 cells exposed to hypoxia to establish the role of TRAP1 in adaptive responses to oxygen deprivation. The results revealed that TRAP1 was involved in regulating hypoxia­induced HIF­1α stabilization and glycolytic metabolism and that glucose transporter 1 expression, glucose uptake and lactate production were partially impaired in TRAP1­silenced CRC cells under hypoxic conditions. At the transcriptional level, the gene expression reprogramming of cancer cells driven by HIF­1α was partially inhibited in TRAP1­silenced CRC cells and organoids exposed to hypoxia. Moreover, Gene Set Enrichment Analysis of TRAP1­silenced HCT116 cells exposed to hypoxia demonstrated that TRAP1 was involved in the regulation of ribosome biogenesis and this occurred with the inhibition of the mTOR pathway. Therefore, as demonstrated herein, TRAP1 is a key factor in maintaining HIF­1α­induced genetic/metabolic program under hypoxic conditions and may represent a promising target for novel metabolic therapies.

Evidence-Based Second-Line Treatment in RAS Wild-Type/Mutated Metastatic Colorectal Cancer in the Precision Medicine Era.

Target-oriented agents improve metastatic colorectal cancer (mCRC) survival in combination with chemotherapy. However, the majority of patients experience disease progression after first-line treatment and are eligible for second-line approaches. In such a context, antiangiogenic and anti-Epidermal Growth Factor Receptor (EGFR) agents as well as immune checkpoint inhibitors have been approved as second-line options, and RAS and BRAF mutations and microsatellite status represent the molecular drivers that guide therapeutic choices. Patients harboring K- and N-RAS mutations are not eligible for anti-EGFR treatments, and bevacizumab is the only antiangiogenic agent that improves survival in combination with chemotherapy in first-line, regardless of RAS mutational status. Thus, the choice of an appropriate therapy after the progression to a bevacizumab or an EGFR-based first-line treatment should be evaluated according to the patient and disease characteristics and treatment aims. The continuation of bevacizumab beyond progression or its substitution with another anti-angiogenic agents has been shown to increase survival, whereas anti-EGFR monoclonals represent an option in RAS wild-type patients. In addition, specific molecular subgroups, such as BRAF-mutated and Microsatellite Instability-High (MSI-H) mCRCs represent aggressive malignancies that are poorly responsive to standard therapies and deserve targeted approaches. This review provides a critical overview about the state of the art in mCRC second-line treatment and discusses sequential strategies according to key molecular biomarkers.

Obstructive Sleep Apnea Worsens Progression-Free and Overall Survival in Human Metastatic Colorectal Carcinoma.

Sleep disorders have emerged as highly prevalent conditions, and along with improved understanding of such disorders, increased attention has gained the evidence that perturbation in sleep architecture and continuity may initiate, exacerbate, or modulate the phenotypic expression of multiple diseases including cancer. Furthermore, obstructive sleep apnea (OSA) has recently been implicated in increased incidence and more adverse prognosis of cancer in humans. This study was designed to confirm the high prevalence of OSA in human malignancies and assess its prognostic relevance in metastatic colorectal carcinomas (mCRCs). A prospective cohort of 52 subjects, affected by solid histologically confirmed metastatic malignancies, was analyzed, and among them, 29 mCRCs were studied for the prognostic role of OSA. OSA was diagnosed in 34.6% (18/52) of patients with a statistically significant difference in apnea-hyponea index between OSA and non-OSA subgroups (14.2 ± 12.2 vs. 2.1 ± 1.5, p < 0.01). Consistently, OSA was diagnosed in 34.5% (10/29) of mCRCs with lower rates of first-line therapy disease control in OSA compared to non-OSA patients (60% in OSA vs. 94.7% in non-OSA, p=0.03). Of note, progression-free and overall survival rates were significantly shorter in OSA (respectively, 9 and 22 months) compared non-OSA (20 and 40 months) mCRC patients (HR = 2.63; 95% CI 0.88-7.84, p=0.01 for PFS; HR = 3.93; 95% CI 1.13-13.73, p < 0.001 for OS). Finally, the multivariate analysis showed that OSA is an independent prognostic factor for PFS (p=0.0076) and OS (p=0.0017) in this cohort. Altogether, these data suggest that OSA is a potential clinical marker predictor of poor prognosis in patients with mCRC.

IDH1 Targeting as a New Potential Option for Intrahepatic Cholangiocarcinoma Treatment-Current State and Future Perspectives.

Cholangiocarcinoma is a primary malignancy of the biliary tract characterized by late and unspecific symptoms, unfavorable prognosis, and few treatment options. The advent of next-generation sequencing has revealed potential targetable or actionable molecular alterations in biliary tumors. Among several identified genetic alterations, the IDH1 mutation is arousing interest due to its role in epigenetic and metabolic remodeling. Indeed, some IDH1 point mutations induce widespread epigenetic alterations by means of a gain-of-function of the enzyme, which becomes able to produce the oncometabolite 2-hydroxyglutarate, with inhibitory activity on α-ketoglutarate-dependent enzymes, such as DNA and histone demethylases. Thus, its accumulation produces changes in the expression of several key genes involved in cell differentiation and survival. At present, small-molecule inhibitors of IDH1 mutated enzyme are under investigation in preclinical and clinical phases as promising innovative treatments for IDH1-mutated intrahepatic cholangiocarcinomas. This review examines the molecular rationale and the results of preclinical and early-phase studies on novel pharmacological agents targeting mutant IDH1 in cholangiocarcinoma patients. Contextually, it will offer a starting point for discussion on combined therapies with metabolic and epigenetic drugs, to provide molecular support to target the interplay between metabolism and epigenetics, two hallmarks of cancer onset and progression.

Activation of Farnesoid X Receptor impairs the tumor-promoting function of breast cancer-associated fibroblasts.

Cancer-associated Fibroblasts (CAFs), the principal components of tumor microenvironment, play multiple role in breast cancer progression. We have previously shown an oncosuppressive role of the nuclear Farnesoid X Receptor (FXR) in mammary epithelial cancer cells, here we assessed whether FXR activation may affect CAF tumor-promoting features. We showed that FXR is expressed in human CAFs isolated from four patients and treatment with the selective FXR agonist GW4064 decreased CAF migration, stress-fiber formation and contractility. RNA-sequencing highlighted cell movement and pathways known to govern cell cytoskeleton organization and migration among the most down-regulated functions and ingenuity canonical pathways upon GW4064 treatment. FXR activation reduced expression of different secreted factors. Coculture experiments revealed a reduced growth and motility of breast cancer cells treated with conditioned-media derived from GW4064-treated CAFs. Increased FXR levels in bulk tumors correlated with a longer patient survival. Our results evidence that FXR activation inhibits tumor-stimulatory activities of CAFs by impacting their mechanical properties and their paracrine signaling repertoire, suggesting that nuclear FXR ligands, by targeting both neoplastic cells and supportive stroma, may represent a promising avenue for the future management of breast cancer.

The nuclear receptor ERß engages AGO2 in regulation of gene transcription, RNA splicing and RISC loading.

BACKGROUND: The RNA-binding protein Argonaute 2 (AGO2) is a key effector of RNA-silencing pathways It exerts a pivotal role in microRNA maturation and activity and can modulate chromatin remodeling, transcriptional gene regulation and RNA splicing. Estrogen receptor beta (ERß) is endowed with oncosuppressive activities, antagonizing hormone-induced carcinogenesis and inhibiting growth and oncogenic functions in luminal-like breast cancers (BCs), where its expression correlates with a better prognosis of the disease. RESULTS: Applying interaction proteomics coupled to mass spectrometry to characterize nuclear factors cooperating with ERß in gene regulation, we identify AGO2 as a novel partner of ERß in human BC cells. ERß-AGO2 association was confirmed in vitro and in vivo in both the nucleus and cytoplasm and is shown to be RNA-mediated. ChIP-Seq demonstrates AGO2 association with a large number of ERß binding sites, and total and nascent RNA-Seq in ERß + vs ERß - cells, and before and after AGO2 knock-down in ERß + cells, reveals a widespread involvement of this factor in ERß-mediated regulation of gene transcription rate and RNA splicing. Moreover, isolation and sequencing by RIP-Seq of ERß-associated long and small RNAs in the cytoplasm suggests involvement of the nuclear receptor in RISC loading, indicating that it may also be able to directly control mRNA translation efficiency and stability. CONCLUSIONS: These results demonstrate that AGO2 can act as a pleiotropic functional partner of ERß, indicating that both factors are endowed with multiple roles in the control of key cellular functions.

Expression and Function of Phosphodiesterase Type 5 in Human Breast Cancer Cell Lines and Tissues: Implications for Targeted Therapy.

PURPOSE: By catalyzing cGMP hydrolysis, phosphodiesterase (PDE) 5 is a critical regulator of its concentration and effects in different (patho)physiologic processes, including cancers. As PDE5 is a known druggable target, we investigated the clinical significance of its expression in breast cancer and the underlying mechanisms by which it may contribute to tumor progression. EXPERIMENTAL DESIGN: PDE5 expression was evaluated in seven breast cancer cell lines by RT-PCR and immunoblotting. To examine the impact of PDE5 on cancer phenotype, MCF-7 cells expressing lower levels of the enzyme were engineered to stably overexpress PDE5. Proliferation was evaluated by MTT assays, motility and invasion by wound-healing/transmigration/invasion assays, transcriptome-profiling by RNA-sequencing, and Rho GTPase signaling activation by GST-pulldown assays and immunoblotting. Clinical relevance was investigated by IHC on tissues and retrospective studies from METABRIC cohort. RESULTS: PDE5 is differentially expressed in each molecular subtype of both breast cancer cell lines and tissues, with higher levels representing a startling feature of HER2-positive and triple-negative breast cancers. A positive correlation was established between elevated PDE5 levels and cancers of high histologic grade. Higher PDE5 expression correlated with shorter patient survival in retrospective analyses. On molecular level, stable PDE5 overexpression in Luminal-A-like MCF-7 cells resulted in enhanced motility and invasion through Rho GTPase signaling activation. Treatment of PDE5-stable clones with selective ROCK or PDE5 inhibitors completely restored the less motile and weak invasive behavior of control vector cells. CONCLUSIONS: PDE5 expression enhances breast cancer cell invasive potential, highlighting this enzyme as a novel prognostic candidate and an attractive target for future therapy in breast cancers. Clin Cancer Res; 22(9); 2271-82. ©2015 AACR.

Small non-coding RNA deregulation in endometrial carcinogenesis.

Small non-coding RNAs (sncRNAs) represent a heterogeneous group of <200nt-long transcripts comprising microRNAs, PIWI-interacting RNAs (piRNAs) and small-nucleolar-RNAs (snoRNAs) involved in physiological and pathological processes such as carcinogenesis and tumor progression. Aberrant sncRNA expression in cancer has been associated with specific clinical phenotypes, grading, staging, metastases development and resistance to therapy.Aim of the present work is to study the role of sncRNAs in endometrial carcinogenesis. Changes in sncRNA expression were identified by high-throughput genomic analysis of paired normal, hyperplastic and cancerous endometrial tissues obtained by endometrial biopsies (n = 10). Using smallRNA sequencing and microarrays we identified significant differences in sncRNA expression pattern between normal, hyperplastic and neoplastic endometrium. This led to the definition of a sncRNA signature (129 microRNAs, 2 of which not previously described, 10 piRNAs and 3 snoRNAs) of neoplastic transformation. Functional bioinformatics analysis identified as downstream targets multiple signaling pathways potentially involved in the hyperplastic and neoplastic tissue responses, including Wnt/ß-catenin, and ERK/MAPK and TGF-ß-Signaling.Considering the regulatory role of sncRNAs, this newly identified sncRNA signature is likely to reflect the events leading to endometrial cancer, which can be exploited to dissect the carcinogenic process including novel biomarkers for early and non-invasive diagnosis of these tumors.

Complex role of monoacylglycerols in the oxidation of vegetable oils: different behaviors of soybean monoacylglycerols in different oils.

The relationship between fatty acid composition of oils and their oxidative stability in the presence of monoacylglycerols was investigated. Purified vegetable oils were added at increasing amounts (0.5, 1, 2, and 3%) of monoacylglycerols obtained from purified soybean oil and submitted to an oven test (60 °C for 18 days). The obtained results showed a generally antioxidant effect of monoacylglycerols, with remarkable differences among oils. The antioxidant effect was significantly higher in less unsaturated oils, such as palm and olive oils. Among the more unsaturated vegetable oils, peanut and sunflower oils showed an almost linear slowdown of oxidation, slightly less pronounced in sunflower oil, which was the most susceptible to oxidation due to its high content of linoleic acid. A peculiar trend was highlighted for soybean oil, where the antioxidant effect of high amounts of monoacylglycerols was opposed to a pro-oxidant effect observed up to 1%.

Effects of monoacylglycerols on the oxidative stability of olive oil.

BACKGROUND: The study of pro- and anti-oxidant compounds is important for their influence on the shelf-life and nutritional value of food. The aim of this research was to evaluate the activity of monoacylglycerols (MAG), obtained by partial saponification of a purified olive oil, added in increasing amounts to the same oil and submitted to the Rancimat test and oven test at 60 °C. Besides routine analyses, high-performance size exclusion chromatography analysis of polar compounds was performed. RESULTS: The addition of MAG led in all cases to a significant slowdown of the oxidative processes. These trends were more evident as the oxidation went on. The purified oil added with 30 g kg(-1) of MAG after 9 days of oven test at 60 °C presented a level of oxidative degradation significantly lower than the control after only 4 days. CONCLUSION: The data showed a marked antioxidant effect of MAG in purified olive oil, contrary to what has been observed by other authors, who noticed either a pro-oxidant or a non-antioxidant activity of these compounds in soybean oil. A different behaviour of MAG during oxidation could depend on the different fatty acid composition of the oil matter they are added to.

Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida / Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients

JUSTIFICATIVA E OBJETIVOS: Comparou-se a ação de duas drogas coadjuvantes da anestesia, remifentanil e dexmedetomidina, na recuperação anestésica e na evolução do pH e da PaCO2, em pacientes com obesidade mórbida que foram submetidos à cirurgia de Capella. MÉTODO: O estudo foi aleatório, prospectivo e duplamente encoberto. Noventa e dois pacientes foram designados a um de dois grupos e submetidos à técnica anestésica (geral/peridural) padronizada. O grupo Remifentanil (Grupo R) e o da Dexmedetomidina (Grupo D) receberam infusão contínua por via venosa destas drogas (0,1 µg.kg-1.min-1 e 0,5 µg.kg-1.h-1 peso ideal mais 30% para ambas) logo após a intubação traqueal. Os pacientes foram monitorizados com pressão arterial média invasiva, oximetria de pulso, EEG bispectral (BIS), capnografia, estimulador de nervo periférico e ECG. Foram avaliados: 1) diferentes tempos de recuperação anestésica (abertura dos olhos, reinicio da respiração espontânea, tempo de extubação traqueal, tempo para de alta da sala de recuperação pós-anestésica e hospitalar), 2) a evolução da gasometria arterial, e 3) analgesia pós-operatória. RESULTADOS: Oitenta e oito pacientes foram avaliados. Os pacientes do grupo R apresentaram abertura ocular precoce (9,49 ± 5,61 min versus 18,25 ± 10,24 min, p < 0,0001), menor tempo para reiniciar a ventilação espontânea (9,78 ± 5,80 min versus 16,58 ± 6,07 min, p < 0,0001), e menor tempo para a extubação traqueal (17,93 ± 10,39 min versus 27,53 ± 13,39 min, p < 0,0001). Não houve diferença quanto ao tempo para alta anestésica (105,18 ± 50,82 min versus 118,69 ± 56,18 min) e para alta ...

[Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients.]. / Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida.

BACKGROUND AND OBJECTIVES: Two coadjuvant anesthetic drugs - remifentanil and dexmedetomidine - were compared in terms of anesthetic recovery, arterial pH and PaCO2 evolution, in morbidly obese patients submitted to Capella's surgery. METHODS: Participated in this prospective, randomized and double blind study 92 patients divided in two groups and submitted to standardized anesthetic technique (general/epidural). Remifentanil Group (Group R) and Dexmedetomidine Group (Group D) received continuous intravenous infusion of these drugs (0.1 microg.kg-1.min-1 and 0.5 microg.kg-1.h-1, ideal body weight plus 30% for both) immediately after tracheal intubation. Monitoring consisted of invasive mean blood pressure, pulse oximetry, BIS EEG, capnography, peripheral nerve stimulator and EKG. The following parameters were evaluated: 1) different anesthetic recovery times (eye opening, return to spontaneous ventilation, tracheal extubation time, time for post anesthetic recovery unit and hospital discharge); 2) arterial blood gas analysis evolution; and 3) postoperative analgesia. RESULTS: Evaluation was possible in 88 patients. Patients group R had earlier eye opening (9.49 +/- 5.61 min versus 18.25 +/- 10.24 min, p < 0.0001), faster return to spontaneous ventilation (9.78 +/- 5.80 min versus 16.58 +/- 6.07 min, p < 0.0001), and earlier tracheal extubation (17.93 +/- 10.39 min versus 27.53 +/- 13.39 min, p < 0.0001). There were no differences in times for post-anesthetic recovery unit (105.18 +/- 50.82 min versus 118.69 +/- 56.18 min) and hospital (51.13 +/- 6.37 hours versus 52.50 +/- 7.09 hours) discharge. Both groups showed arterial pH and PaO2 decrease immediately after tracheal extubation as compared to preoperative values, still present at PACU discharge. Group D patients showed higher arterial PaCO2 after tracheal extubation, as compared to preoperative values in the same group (p < 0.05), and opposed to Group R. 41% of Group R and 60% Group D patients (p < 0.02) required rescue analgesia during the first postoperative day. CONCLUSIONS: In the studied population, the association of remifentanil to standardized anesthetic technique has resulted in faster anesthetic recovery, stability of preoperative arterial PaCO2 values during the immediate postoperative period and lower postoperative rescue analgesics consumption, as compared to dexmedetomidine.