Programme(s) to which this project applies:
|☒ MPhil/PhD||☑ MRes[Med]||☒ URIS|
Area of Research
Anaesthesia; cancer; randomised controlled trial
Objective and Significance
Retrospective studies have shown that patients with cancer who undergo resection under propofol total intravenous anaesthesia (TIVA) have better 5-year disease-free survival when compared to patients who have inhalational anaesthesia. The mechanism of this beneficial effect is unknown. This study aims to investigate:
If there are changes in gene expression and plasma concentrations of inflammatory biomarkers (HIF-1, IL-6, and TNF-alpha) and DNA damage induced by surgery and whether these changes are different between different methods of anaesthesia;
Whether tumour cells are released into the circulation during surgery, whether they persist in the circulation in the hours’ post-surgery, and whether the persistence is different between the different modes of anaesthesia;
Whether there are any differences in three-year survival between patients who undergo tumour resection under the two different modes of anaesthesia.
Research Plan and Methodology
Study design, patients and methods: a randomised, controlled trial on patients with hepatocellular carcinoma undergoing open hepatectomy or laparoscopic tumour resection. Patients will be randomised to receive TIVA or inhalational anaesthesia.
Peripheral blood will be taken from patients prior to the start of anaesthesia, immediately after tumour resection, 30 minutes after the end of anaesthesia and at 24 hours’ post-surgery.
Biomarkers of immunity and inflammation, circulating tumour cells and DNA damage will be investigated in the blood taken at the four timepoints.
Patients will also be followed-up for cancer recurrence, morbidity and five-year mortality through the CMS. Other anaesthesia and cancer studies are being planned to follow this.
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