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Analysis of neuraxial anesthesia and the prognosis of Prostate Cancer

Grant number: 19/16459-9
Support type:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): October 01, 2019
Effective date (End): September 30, 2023
Field of knowledge:Health Sciences - Medicine - Surgery
Principal Investigator:Sabrina Thalita dos Reis Faria
Grantee:Gustavo Noboru Cavallari Inoue
Home Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Prostate Cancer (PC) is among the most common cancers in men around the world and causes thousands of deaths annually. One of the treatment options for localized PC is surgical removal of the organ, known as radical prostatectomy. Although surgical technique has evolved considerably in recent years, especially with less invasive techniques such as videolaparoscopy and robotic surgery, radical prostatectomy can still cause damage and hemodynamic changes in patients undergoing this procedure. Surgical insult causes neurohumoral changes in the body due to the interaction between the autonomic and endocrine nervous systems. This neuro-endocrine stress alters the production of cytokines responsible for activation of some cells immune system cells, such as natural killer lymphocytes (NK), which play an important role in body's defense against metastatic potential cells. Secretion of pro-angiogenic factors is also altered during surgical trauma. In addition, the tumor surgical manipulation itself may induce the spread of metastases. In this context, anesthesia plays an important role in oncological surgeries. Several studies in the literature have shown that some classes of anesthetic drugs or even anesthetic techniques may be advantageous for the neuroendocrine response in this type of surgery, with local anesthetics and regional blockages gaining prominence in this context. However, little is known about the real role of these anesthetic techniques in long-term prognosis of metastases after the surgical treatment of supposedly localized prostate tumors. In the present study, we propose to compare efficacy in the prevention of possible metastases between combined anesthesia (spinal anesthesia and general anesthesia) and general anesthesia in an in vivo model of PC. This work aims to detect changes in NK cell activity, inflammatory interleukin levels, tumor cell counts and DNA methylation in mice with subcutaneous prostate tumors undergoing surgical trauma during different types of anesthetic techniques. (AU)