Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Dec 27, 2012; 4(12): 284-288
Published online Dec 27, 2012. doi: 10.4240/wjgs.v4.i12.284
Does perioperative prostaglandin E1 affect survival of patients with esophageal cancer?
Fahimeh Farrokhnia, Jalil Makarem, Habibollah Mahmoodzadeh, Nazanin Andalib
Fahimeh Farrokhnia, Department of Anesthesiology, the Cancer Institute, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran 15614, Iran
Jalil Makarem, Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran 15614, Iran
Habibollah Mahmoodzadeh, Department of Surgery, the Cancer Institute, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran 15614, Iran
Nazanin Andalib, School of Biology, Campus of Science, University of Tehran, Tehran, Iran
Author contributions: Farrokhnia F, Makarem J, Mahmoodzadeh H and Andalib N contributed equally to the paper.
Supported by The Cancer Research Center of the Cancer Institute in Iran
Correspondence to: Fahimeh Farrokhnia, MD, Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Keshavarz Blvd, Tehran 15614, Iran. farrokhnia1503@yahoo.com
Telephone: +98-21-66438634 Fax: +98-21-66438634
Received: August 20, 2011
Revised: October 17, 2012
Accepted: December 20, 2012
Published online: December 27, 2012
Abstract

AIM: To detect the effect of intraoperative prostaglandin E1 (PGE1) infusion on survival of esophagectomized patients due to cancer.

METHODS: In this preliminary study, a double blinded placebo based clinical trial was performed. Thirty patients with esophageal cancer scheduled for esophagectomy via the transthoracic approach were randomized by a block randomization method, in two equal groups: PGE1 group - infusion of PGE1 (20 ng/kg per minute) in the operating room and placebo group - saline 0.9% with the same volume and rate. The infusion began before induction of anesthesia and finished just before transfer to the intensive care unit. The patients, anesthetist, intensive care physicians, nurses and surgeons were blinded to both study groups. All the patients were anesthetized with the same method. For postoperative pain control, a thoracic epidural catheter was placed for all patients before induction of anesthesia. We followed up the patients until October 2010. Basic characteristics, duration of anesthesia, total surgery and thoracotomy time, preoperative hemoglobin, length of tumor, grade of histological differentiation, disease stage, number of lymph nodes in the resected mass, number of readmissions to hospital, total duration of readmission and survival rates were compared between the two groups. Some of the data originates from the historical data reported in our previous study. We report them for better realization of the follow up results.

RESULTS: The patients’ characteristics and perioperative variables were compared between the two groups. There were no significant differences in age (P = 0.48), gender (P = 0.27), body mass index (P = 0.77), American Society of Anesthesiologists physical status more than I (P = 0.71), and smoking (P = 0.65). The PGE1 and placebo group were comparable in the following variables: duration of anesthesia (277 ± 50 vs 270 ± 67, P = 0.86), duration of thoracotomy (89 ± 35 vs 96 ± 19, P = 0.46), duration of operation (234 ± 37 vs 240 ± 66, P = 0.75), volume of blood loss during operation (520 ± 130 vs 630 ± 330, P = 0.34), and preoperative hemoglobin (14.4 ± 2 vs 14.7 ± 1.9, P = 0.62), respectively. No hemodynamic complications requiring an infusion of dopamine or cessation of the PGE1 infusion were encountered. Cancer variables were compared between the PGE1 and placebo group. Length of tumor (11.9 ± 3 vs 12.3 ± 3, P = 0.83), poor/undifferentiated grade of histological differentiation [3 (20%) vs 3 (20%), P = 0.78], disease stage III [5 (33.3%), 4 (26.7%), P = 0.72] and more than 3 lymph nodes in the resected mass [3 (20%) vs 2 (13.3%), P = 0.79] were similar in both groups. All the patients were discharged from hospital except one patient in the control group who died because of a post operative myocardial infarction. No life threatening postoperative complication occurred in any patient. The results of outcome and survival were the same in PGE1 and placebo group: number of readmissions (2.1 ± 1 vs 1.9 ± 1, P = 0.61), total duration of readmission (27 ± 12 vs 29 ± 12, P = 0.67), survival rate (10.1 ± 3.8 vs 9.6 ± 3.4, P = 0.71), overall survival rate after one year [8 (53.3%) vs 7 (47%), P = 0.72], overall survival rate after two years [3 (20%) vs 3 (20%), P = 0.99], and overall survival rate after three years [0 vs 1 (6.7%), P = 0.99], respectively.

CONCLUSION: In conclusion, PGE1 did not shorten or lengthen the survival of patients with esophageal cancer. Larger studies are suggested.

Keywords: Prostaglandin E1; Esophagectomy; Cancer; Survival; Surgery