Back to resultsEpidural Anesthesia-analgesia and Long-term Survival After Lung Cancer Surgery
Primary Purpose
Lung Cancer, Thoracic Surgery, Anesthesia, Epidural
Status
Completed
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
General anesthesia alone
Combined epidural-general anesthesia
Sponsored by
About this trial
This is an interventional prevention trial for Lung Cancer focused on measuring Lung Cancer, Surgical Resection, Epidural Anesthesia and Analgesia, Cancer recurrence/metastasis, Long-Term Outcome
Eligibility Criteria
Inclusion Criteria:
- Adult patients (aged 18-80 years);
- Clinically diagnosed as primary non-small cell lung cancer of stage IA to IIIA, and scheduled for radical surgery;
- Agreed to receive patient-controlled analgesia after surgery.
Exclusion Criteria:
- Distant metastasis, malignant tumor in other organs, or chemo-/radiotherapy or other anti-cancer therapy before surgery;
- Comorbid with autoimmune diseases, or glucocorticoid/immunosuppressant therapy within 1 year;
- History of schizophrenia, epilepsy or Parkinson disease, or unable to complete preoperative assessment due to severe dementia, language barrier, or end-stage disease;
- Severe hepatic disease (Child-Pugh classification C), renal failure (serum creatinine >442 umol/L or receiving renal replacement therapy), or American Society of Anesthesiologists classification IV or higher;
- History of anesthesia and/or surgery within 1 year;
- Contraindications to epidural anesthesia, including spinal deformity, coagulation dysfunction, local infection, and history of spinal trauma/surgery;
- Allergic to any medications used during the study.
Sites / Locations
- Peking University First Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Experimental
Arm Label
General anesthesia alone
Combined epidural-general anesthesia
Arm Description
General anesthesia is performed during surgery; patient-controlled intravenous analgesia is provided after surgery.
Combined epidural-general anesthesia is performed during surgery; patient-controlled epidural analgesia is provided after surgery.
Outcomes
Primary Outcome Measures
Recurrence-free survival after surgery.
Time from surgery to the earliest date of recurrence/metastasis or death from any cause, whichever came first.
Secondary Outcome Measures
Rate of intensive care unit admission after surgery.
Rate of intensive care unit admission after surgery.
Incidence of postoperative complications during hospital stay.
Postoperative complications are defined as new-onset conditions that are harmful to patients' recovery and required therapeutic intervention, i.e., class II or higher on the Clavien-Dindo classification.
Duration of chest tube placement.
Duration of chest tube placement.
Length of stay in hospital after surgery.
Length of stay in hospital after surgery.
Rate of all-cause mortality during hospital stay after surgery.
Rate of all-cause mortality during hospital stay after surgery.
Overall survival rate after surgery.
Time from surgery to all-cause death.
Cancer-specific survival after surgery.
Time from surgery to cancer-specific death; deaths from other causes are censored at the time of death.
Activity engagement in 1-year survivors.
Activity engagement is assessed by estimating metabolic equivalents (METs; 1 MET = 3·5 ml/min/kg resting oxygen consumption) for activity in daily life.
Full Information
NCT ID
NCT02801409
First Posted
June 12, 2016
Last Updated
August 25, 2020
Sponsor
Peking University First Hospital
1. Study Identification
Unique Protocol Identification Number
NCT02801409
Brief Title
Epidural Anesthesia-analgesia and Long-term Survival After Lung Cancer Surgery
Official Title
Effects of Epidural Anesthesia-analgesia on Long-term Survival in Patients After Lung Cancer Surgery: A Randomized Controlled Trial
Study Type
Interventional
2. Study Status
Record Verification Date
August 2020
Overall Recruitment Status
Completed
Study Start Date
May 25, 2015 (Actual)
Primary Completion Date
November 11, 2017 (Actual)
Study Completion Date
November 30, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Peking University First Hospital
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Available studies suggest that regional anesthesia-analgesia may decrease the occurrence of recurrence/metastasis in patients after cancer surgery. However, evidences from prospective studies are still lacking. The purpose of this randomized controlled trial is to investigate the effect of epidural anesthesia-analgesia on recurrence-free survival in patients undergoing lung cancer surgery.
Detailed Description
Lung cancer is increasing and is the leading cause of cancer death. Surgical resection is the mainstay of treatment for early stage non-small cell lung cancer. However, long-term survival after lung cancer surgery is far from optimal, and cancer recurrence or metastasis is the main reason leading to cancer death in these patients.
The development of cancer recurrence/metastasis largely depends on the balance between tumor-promoting factors and immune function of the body. Studies showed that surgical manipulation releases cancer cells into circulation; and stress response induced by surgery inhibits the cell-mediated immunity. In addition, volatile anesthetics and opioids may also aggravate immunosuppression and potentially worsen long-term outcome. On the other hand, regional anesthesia can blunt surgical stress and reduce anesthetic consumption. These effects may help to preserve immune function and reduce recurrence/metastasis. However, existing evidences are insufficient to draw conclusion in this topic.
The purpose of this randomized controlled trial is to test the hypothesize that regional anesthesia-analgesia may reduce recurrence/metastasis and improve long-term survival in patients after lung cancer surgery.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lung Cancer, Thoracic Surgery, Anesthesia, Epidural, Neoplasm Recurrence, Local, Neoplasm Metastasis
Keywords
Lung Cancer, Surgical Resection, Epidural Anesthesia and Analgesia, Cancer recurrence/metastasis, Long-Term Outcome
7. Study Design
Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
400 (Actual)
8. Arms, Groups, and Interventions
Arm Title
General anesthesia alone
Arm Type
Active Comparator
Arm Description
General anesthesia is performed during surgery; patient-controlled intravenous analgesia is provided after surgery.
Arm Title
Combined epidural-general anesthesia
Arm Type
Experimental
Arm Description
Combined epidural-general anesthesia is performed during surgery; patient-controlled epidural analgesia is provided after surgery.
Intervention Type
Drug
Intervention Name(s)
General anesthesia alone
Intervention Description
General anesthesia is performed during surgery; patient-controlled intravenous analgesia is provided after surgery.
Intervention Type
Drug
Intervention Name(s)
Combined epidural-general anesthesia
Intervention Description
Combined epidural-general anesthesia is performed during surgery; patient-controlled epidural analgesia is provided after surgery.
Primary Outcome Measure Information:
Title
Recurrence-free survival after surgery.
Description
Time from surgery to the earliest date of recurrence/metastasis or death from any cause, whichever came first.
Time Frame
Up to 4 years after surgery.
Secondary Outcome Measure Information:
Title
Rate of intensive care unit admission after surgery.
Description
Rate of intensive care unit admission after surgery.
Time Frame
Up to 30 days after surgery.
Title
Incidence of postoperative complications during hospital stay.
Description
Postoperative complications are defined as new-onset conditions that are harmful to patients' recovery and required therapeutic intervention, i.e., class II or higher on the Clavien-Dindo classification.
Time Frame
Up to 30 days after surgery.
Title
Duration of chest tube placement.
Description
Duration of chest tube placement.
Time Frame
Up to 30 days after surgery.
Title
Length of stay in hospital after surgery.
Description
Length of stay in hospital after surgery.
Time Frame
Up to 30 days after surgery.
Title
Rate of all-cause mortality during hospital stay after surgery.
Description
Rate of all-cause mortality during hospital stay after surgery.
Time Frame
Up to 30 days after surgery.
Title
Overall survival rate after surgery.
Description
Time from surgery to all-cause death.
Time Frame
Up to 4 year after surgery.
Title
Cancer-specific survival after surgery.
Description
Time from surgery to cancer-specific death; deaths from other causes are censored at the time of death.
Time Frame
Up to 4 years after surgery.
Title
Activity engagement in 1-year survivors.
Description
Activity engagement is assessed by estimating metabolic equivalents (METs; 1 MET = 3·5 ml/min/kg resting oxygen consumption) for activity in daily life.
Time Frame
At the end of the first year after surgery.
Other Pre-specified Outcome Measures:
Title
Pain intensity after surgery.
Description
Assessed with the numeric rating score, an 11-point scale where 0 = no pain and 10 = the most severe pain.
Time Frame
During the first 3 days after surgery.
Title
Recurrence-free survival in cancer patients.
Description
Time from surgery to the earliest date of recurrence/metastasis or death from any cause, whichever came first.
Time Frame
Up to 4 years after surgery.
Title
Overall survival in cancer patients.
Description
Time from surgery to all-cause death.
Time Frame
Up to 4 years after surgery.
Title
Cancer-specific survival in cancer patients.
Description
Time from surgery to cancer-specific death; deaths from other causes are censored at the time of death.
Time Frame
Up to 4 years after surgery.
Title
Number of CD8+ and FOXP3+ T cells per mm2 tumor area (sub-study).
Description
Immunohistochemical staining of CD8 and FOXP3 molecules in excised lung adenocarcinoma specimens. Performed in part of enrolled patients.
Time Frame
After resection of lung adenocarcinoma specimens
Title
Percentage of NK-cells and T-cell subgroups in peripheral blood (sub-study).
Description
Measured by flow cytometry. Performed in part of enrolled patients.
Time Frame
Peripheral blood samples collected before induction, at the end of surgery and at 24 hours after surgery.
Title
Rate of chronic pain at 3 month and 6 month after surgery (sub-study).
Description
Chronic pain is measured with the Brief Pain Inventory (BPI), neuropathic pain screening questionnaire (ID pain), and McGill Pain Questionnair (MPQ). Performed in part of enrolled patients.
Time Frame
At 3 months and 6 months after surgery.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Adult patients (aged 18-80 years);
Clinically diagnosed as primary non-small cell lung cancer of stage IA to IIIA, and scheduled for radical surgery;
Agreed to receive patient-controlled analgesia after surgery.
Exclusion Criteria:
Distant metastasis, malignant tumor in other organs, or chemo-/radiotherapy or other anti-cancer therapy before surgery;
Comorbid with autoimmune diseases, or glucocorticoid/immunosuppressant therapy within 1 year;
History of schizophrenia, epilepsy or Parkinson disease, or unable to complete preoperative assessment due to severe dementia, language barrier, or end-stage disease;
Severe hepatic disease (Child-Pugh classification C), renal failure (serum creatinine >442 umol/L or receiving renal replacement therapy), or American Society of Anesthesiologists classification IV or higher;
History of anesthesia and/or surgery within 1 year;
Contraindications to epidural anesthesia, including spinal deformity, coagulation dysfunction, local infection, and history of spinal trauma/surgery;
Allergic to any medications used during the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dong-Xin Wang, MD, PhD
Organizational Affiliation
Peking University First Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peking University First Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100034
Country
China
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
19672942
Citation
Kelsey CR, Marks LB, Hollis D, Hubbs JL, Ready NE, D'Amico TA, Boyd JA. Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients. Cancer. 2009 Nov 15;115(22):5218-27. doi: 10.1002/cncr.24625.
Results Reference
background
PubMed Identifier
10543475
Citation
Sawyer TE, Bonner JA, Gould PM, Foote RL, Deschamps C, Lange CM, Li H. Factors predicting patterns of recurrence after resection of N1 non-small cell lung carcinoma. Ann Thorac Surg. 1999 Oct;68(4):1171-6. doi: 10.1016/s0003-4975(99)00678-5.
Results Reference
background
PubMed Identifier
20627881
Citation
Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010 Aug;105(2):106-15. doi: 10.1093/bja/aeq164.
Results Reference
background
PubMed Identifier
18026089
Citation
Koebel CM, Vermi W, Swann JB, Zerafa N, Rodig SJ, Old LJ, Smyth MJ, Schreiber RD. Adaptive immunity maintains occult cancer in an equilibrium state. Nature. 2007 Dec 6;450(7171):903-7. doi: 10.1038/nature06309. Epub 2007 Nov 18.
Results Reference
background
PubMed Identifier
14527919
Citation
Shakhar G, Ben-Eliyahu S. Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol. 2003 Oct;10(8):972-92. doi: 10.1245/aso.2003.02.007.
Results Reference
background
PubMed Identifier
10862196
Citation
Yamaguchi K, Takagi Y, Aoki S, Futamura M, Saji S. Significant detection of circulating cancer cells in the blood by reverse transcriptase-polymerase chain reaction during colorectal cancer resection. Ann Surg. 2000 Jul;232(1):58-65. doi: 10.1097/00000658-200007000-00009.
Results Reference
background
PubMed Identifier
10336800
Citation
Hofer SO, Molema G, Hermens RA, Wanebo HJ, Reichner JS, Hoekstra HJ. The effect of surgical wounding on tumour development. Eur J Surg Oncol. 1999 Jun;25(3):231-43. doi: 10.1053/ejso.1998.0634.
Results Reference
background
PubMed Identifier
2412626
Citation
Lennard TW, Shenton BK, Borzotta A, Donnelly PK, White M, Gerrie LM, Proud G, Taylor RM. The influence of surgical operations on components of the human immune system. Br J Surg. 1985 Oct;72(10):771-6. doi: 10.1002/bjs.1800721002.
Results Reference
background
PubMed Identifier
11685934
Citation
Carter JJ, Whelan RL. The immunologic consequences of laparoscopy in oncology. Surg Oncol Clin N Am. 2001 Jul;10(3):655-77.
Results Reference
background
PubMed Identifier
10501289
Citation
Tashiro T, Yamamori H, Takagi K, Hayashi N, Furukawa K, Nitta H, Toyoda Y, Sano W, Itabashi T, Nishiya K, Hirano J, Nakajima N. Changes in immune function following surgery for esophageal carcinoma. Nutrition. 1999 Oct;15(10):760-6. doi: 10.1016/s0899-9007(99)00151-3.
Results Reference
background
PubMed Identifier
10825740
Citation
Downing JE, Miyan JA. Neural immunoregulation: emerging roles for nerves in immune homeostasis and disease. Immunol Today. 2000 Jun;21(6):281-9. doi: 10.1016/s0167-5699(00)01635-2.
Results Reference
background
PubMed Identifier
11121511
Citation
Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve--an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev. 2000 Dec;52(4):595-638.
Results Reference
background
PubMed Identifier
11166986
Citation
Page GG, Blakely WP, Ben-Eliyahu S. Evidence that postoperative pain is a mediator of the tumor-promoting effects of surgery in rats. Pain. 2001 Feb 1;90(1-2):191-9. doi: 10.1016/s0304-3959(00)00403-6.
Results Reference
background
PubMed Identifier
21852973
Citation
Afsharimani B, Cabot PJ, Parat MO. Morphine use in cancer surgery. Front Pharmacol. 2011 Aug 8;2:46. doi: 10.3389/fphar.2011.00046. eCollection 2011.
Results Reference
background
PubMed Identifier
9498507
Citation
Xu YX, Ayala A, Chaudry IH. Prolonged immunodepression after trauma and hemorrhagic shock. J Trauma. 1998 Feb;44(2):335-41. doi: 10.1097/00005373-199802000-00018.
Results Reference
background
PubMed Identifier
10485799
Citation
Klein HG. Immunomodulatory aspects of transfusion: a once and future risk? Anesthesiology. 1999 Sep;91(3):861-5. doi: 10.1097/00000542-199909000-00040. No abstract available.
Results Reference
background
PubMed Identifier
20435944
Citation
Gottschalk A, Sharma S, Ford J, Durieux ME, Tiouririne M. Review article: the role of the perioperative period in recurrence after cancer surgery. Anesth Analg. 2010 Jun 1;110(6):1636-43. doi: 10.1213/ANE.0b013e3181de0ab6. Epub 2010 Apr 30.
Results Reference
background
PubMed Identifier
10451907
Citation
Ishihara Y, Matsunaga K, Iijima H, Fujii T, Oguchi Y, Kagawa J. Time-dependent effects of stressor application on metastasis of tumor cells in the lung and its regulation by an immunomodulator in mice. Psychoneuroendocrinology. 1999 Oct;24(7):713-26. doi: 10.1016/s0306-4530(99)00023-2.
Results Reference
background
PubMed Identifier
8221628
Citation
Freire-Garabal M, Nunez MJ, Balboa JL, Fernandez-Rial JC, Vallejo LG, Gonzalez-Bahillo J, Rey-Mendez M. Effects of alprazolam on cellular immune response to surgical stress in mice. Cancer Lett. 1993 Sep 30;73(2-3):155-60. doi: 10.1016/0304-3835(93)90258-b.
Results Reference
background
PubMed Identifier
9428780
Citation
Andersen BL, Farrar WB, Golden-Kreutz D, Kutz LA, MacCallum R, Courtney ME, Glaser R. Stress and immune responses after surgical treatment for regional breast cancer. J Natl Cancer Inst. 1998 Jan 7;90(1):30-6. doi: 10.1093/jnci/90.1.30.
Results Reference
background
PubMed Identifier
23242747
Citation
Heaney A, Buggy DJ. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis? Br J Anaesth. 2012 Dec;109 Suppl 1:i17-i28. doi: 10.1093/bja/aes421.
Results Reference
background
PubMed Identifier
23624071
Citation
Conrick-Martin I, Buggy DJ. The effects of anesthetic and analgesic techniques on immune function. J Clin Anesth. 2013 Jun;25(4):253-4. doi: 10.1016/j.jclinane.2013.04.003. Epub 2013 Apr 26. No abstract available.
Results Reference
background
PubMed Identifier
18922851
Citation
Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E, Hohne C, Fritz G, Keh D. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth. 2008 Dec;101(6):781-7. doi: 10.1093/bja/aen287. Epub 2008 Oct 15.
Results Reference
background
PubMed Identifier
22846676
Citation
Piegeler T, Votta-Velis EG, Liu G, Place AT, Schwartz DE, Beck-Schimmer B, Minshall RD, Borgeat A. Antimetastatic potential of amide-linked local anesthetics: inhibition of lung adenocarcinoma cell migration and inflammatory Src signaling independent of sodium channel blockade. Anesthesiology. 2012 Sep;117(3):548-59. doi: 10.1097/ALN.0b013e3182661977.
Results Reference
background
PubMed Identifier
15966493
Citation
Waurick R, Van Aken H. Update in thoracic epidural anaesthesia. Best Pract Res Clin Anaesthesiol. 2005 Jun;19(2):201-13. doi: 10.1016/j.bpa.2004.12.001.
Results Reference
background
PubMed Identifier
18648226
Citation
Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008 Aug;109(2):180-7. doi: 10.1097/ALN.0b013e31817f5b73.
Results Reference
background
PubMed Identifier
17006061
Citation
Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006 Oct;105(4):660-4. doi: 10.1097/00000542-200610000-00008.
Results Reference
background
PubMed Identifier
19911247
Citation
Tsui BC, Rashiq S, Schopflocher D, Murtha A, Broemling S, Pillay J, Finucane BT. Epidural anesthesia and cancer recurrence rates after radical prostatectomy. Can J Anaesth. 2010 Feb;57(2):107-12. doi: 10.1007/s12630-009-9214-7.
Results Reference
background
PubMed Identifier
21436156
Citation
Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis. Br J Anaesth. 2011 Jun;106(6):814-22. doi: 10.1093/bja/aer055. Epub 2011 Mar 24.
Results Reference
background
PubMed Identifier
22273991
Citation
Cummings KC 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiology. 2012 Apr;116(4):797-806. doi: 10.1097/ALN.0b013e31824674f6.
Results Reference
background
PubMed Identifier
20573631
Citation
Ismail H, Ho KM, Narayan K, Kondalsamy-Chennakesavan S. Effect of neuraxial anaesthesia on tumour progression in cervical cancer patients treated with brachytherapy: a retrospective cohort study. Br J Anaesth. 2010 Aug;105(2):145-9. doi: 10.1093/bja/aeq156. Epub 2010 Jun 23.
Results Reference
background
PubMed Identifier
22104077
Citation
Lai R, Peng Z, Chen D, Wang X, Xing W, Zeng W, Chen M. The effects of anesthetic technique on cancer recurrence in percutaneous radiofrequency ablation of small hepatocellular carcinoma. Anesth Analg. 2012 Feb;114(2):290-6. doi: 10.1213/ANE.0b013e318239c2e3. Epub 2011 Nov 21. Erratum In: Anesth Analg. 2013 Jan;116(1):266.
Results Reference
background
PubMed Identifier
21586443
Citation
Gupta A, Bjornsson A, Fredriksson M, Hallbook O, Eintrei C. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden. Br J Anaesth. 2011 Aug;107(2):164-70. doi: 10.1093/bja/aer100. Epub 2011 May 17.
Results Reference
background
PubMed Identifier
18635504
Citation
Christopherson R, James KE, Tableman M, Marshall P, Johnson FE. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia. Anesth Analg. 2008 Jul;107(1):325-32. doi: 10.1213/ane.0b013e3181770f55.
Results Reference
background
PubMed Identifier
20508494
Citation
Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, Durieux ME, Nemergut EC. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiology. 2010 Jul;113(1):27-34. doi: 10.1097/ALN.0b013e3181de6d0d.
Results Reference
background
PubMed Identifier
20683253
Citation
Wuethrich PY, Hsu Schmitz SF, Kessler TM, Thalmann GN, Studer UE, Stueber F, Burkhard FC. Potential influence of the anesthetic technique used during open radical prostatectomy on prostate cancer-related outcome: a retrospective study. Anesthesiology. 2010 Sep;113(3):570-6. doi: 10.1097/ALN.0b013e3181e4f6ec.
Results Reference
background
PubMed Identifier
21447587
Citation
Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI; ANZCA Trials Group Investigators. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial. BMJ. 2011 Mar 29;342:d1491. doi: 10.1136/bmj.d1491.
Results Reference
background
PubMed Identifier
22542070
Citation
Taylor MD, Nagji AS, Bhamidipati CM, Theodosakis N, Kozower BD, Lau CL, Jones DR. Tumor recurrence after complete resection for non-small cell lung cancer. Ann Thorac Surg. 2012 Jun;93(6):1813-20; discussion 1820-1. doi: 10.1016/j.athoracsur.2012.03.031. Epub 2012 Apr 26.
Results Reference
background
PubMed Identifier
17207020
Citation
Alberts WM. Follow up and surveillance of the patient with lung cancer: what do you do after surgery? Respirology. 2007 Jan;12(1):16-21. doi: 10.1111/j.1440-1843.2006.00956.x.
Results Reference
background
PubMed Identifier
23649451
Citation
Colt HG, Murgu SD, Korst RJ, Slatore CG, Unger M, Quadrelli S. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e437S-e454S. doi: 10.1378/chest.12-2365.
Results Reference
background
PubMed Identifier
16770229
Citation
Bruzzi JF, Munden RF. PET/CT imaging of lung cancer. J Thorac Imaging. 2006 May;21(2):123-36. doi: 10.1097/00005382-200605000-00004.
Results Reference
background
PubMed Identifier
25548913
Citation
Pei L, Tan G, Wang L, Guo W, Xiao B, Gao X, Wang L, Li H, Xu Z, Zhang X, Zhao J, Yi J, Huang Y. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: a meta-analysis of retrospective and prospective studies. PLoS One. 2014 Dec 30;9(12):e114667. doi: 10.1371/journal.pone.0114667. eCollection 2014.
Results Reference
background
Learn more about this trial
Epidural Anesthesia-analgesia and Long-term Survival After Lung Cancer Surgery
We'll reach out to this number within 24 hrs