BACKGROUND: Opioids and epidural analgesia are a mainstay of perioperative analgesia but their influence on cancer recurrence remains unclear. Based on retrospective data, we found that cancer recurrence following colorectal cancer surgery correlates with the number of circulating tumor cells (CTCs) in the early postoperative period. Also, morphine- but not piritramide-based postoperative analgesia increases the presence of CTCs and shortens cancer-specific survival. The influence of epidural analgesia on CTCs has not been studied yet. METHODS: We intend to enroll 120 patients in four centers in this prospective randomized controlled trial. The study protocol has been approved by Ethics Committees in all participating centers. Patients undergoing radical open colorectal cancer surgery are randomized into epidural, morphine, and piritramide groups for perioperative analgesia. The primary outcome is the difference in the number of CTCs in the peripheral blood before surgery, on the second postoperative day, and 2-4 weeks after surgery. The number of CTCs is measured using molecular biology methods. Perioperative care is standardized, and relevant data is recorded. A secondary outcome, if feasible, would be the expression and activity of various receptor subtypes in cancer tissue. We intend to perform a 5-year follow-up with regard to metastasis development. DISCUSSION: The mode of perioperative analgesia favorably affecting cancer recurrence would decrease morbidity/mortality. To identify such techniques, trials with long-term follow-up periods seem suboptimal. Given complex oncological therapeutic strategies, such trials likely disable the separation of perioperative analgesia effects from other factors. We believe that early postoperative CTCs presence/dynamics may serve as a sensitive marker of various perioperative interventions ́ influences on cancer recurrence. Importantly, it is unbiased to the influence of long-term factors and minimally invasive. Analysis of opioid/cannabinoid receptor subtypes in cancer tissue would improve understanding of underlying mechanisms and promote personalization of treatment. We are not aware of any similar ongoing studies. TRIAL REGISTRATION NUMBER: NCT03700411, registration date: October 3, 2018. STUDY STATUS: recruiting.
- MeSH
- epidurální analgezie * MeSH
- kolorektální nádory * chirurgie MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- morfin MeSH
- multicentrické studie jako téma MeSH
- nádorové cirkulující buňky * MeSH
- opioidní analgetika terapeutické užití MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- protokol klinické studie MeSH
- MeSH
- aorta chirurgie patologie MeSH
- chirurgie plic metody MeSH
- lidé MeSH
- lymfatické metastázy patologie MeSH
- nádory mediastina patologie MeSH
- nádory páteře chirurgie sekundární MeSH
- nádory srdce chirurgie sekundární MeSH
- nemalobuněčný karcinom plic * chirurgie klasifikace patologie MeSH
- pneumektomie metody MeSH
- stupeň nádoru MeSH
- vena cava superior chirurgie patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
Cílem práce je podat souhrnnou informaci o velmi vzácném katameniálním pneumotoraxu. Katameniální pneumotorax je jednou z forem spontánního pneumotoraxu. Nedílnou součástí práce je literární přehled. Autoři uvádějí kasuistiku mladé ženy s katameniálním pneumotoraxem, která prodělala během neúplných 11 měsíců pět epizod spontánního pneumotoraxu.
The objective of the work was to present summarized information on a very rare catamenial pneumothorax. Catamenial pneumothorax is one of the forms of spontaneous pneumothorax. An integral part of the paper is a review of the literature. The authors present the case-record of a young woman with catamenial pneumothorax who suffered in the course of almost 11 months five episodes of spontaneous pneumothorax.
- MeSH
- dospělí MeSH
- kontraceptiva orální hormonální terapeutické užití MeSH
- lidé MeSH
- menstruace MeSH
- pneumotorax diagnóza etiologie chirurgie MeSH
- torakotomie metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
