Association of increased postoperative opioid administration with non-small-cell lung cancer recurrence: A retrospective analysis

D. P. Maher, W. Wong, P. F. White, R. McKenna, H. Rosner, B. Shamloo, C. Louy, R. Wender, R. Yumul, V. Zhang

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Background Evidence suggests that opioid-sparing anaesthetic techniques might be associated with increased cancer-free postoperative survival. This could be related to suppression of natural killer cells by opioid analgesics in the perioperative period. This retrospective analysis tested the hypothesis that greater opioid use in the postoperative period is associated with a higher incidence of recurrences after surgery for lung cancer. Methods The medical records of 99 consecutive patients who underwent video-assisted thoracoscopic surgery with lobectomy for Stage I or IIa biopsy-proven non-small-cell lung cancer (NSCLC) were reviewed. Perioperative information including patient characteristics, laboratory data, and surgical, anaesthetic, nursing, and pharmacy reports were collected. Doses of opioids administered intra-operatively and for the first 96 h after operation were converted into equianalgesic doses of oral morphine using a standard conversion table. Data were then compared with the National Cancer Registry's incidence of disease-free survival for 5 yr. Results A total of 99 patients with similar characteristics were included in the final analysis, 73 of whom were NSCLC recurrence-free at 5 yr and 26 had NSCLC recurrence within 5 yr. Total opioid dose during the 96 h postoperative period was 124 (101) mg of morphine equivalents in the cancer-free group and 232 mg (355) mg in the recurrence group (P=0.02). Conclusions This retrospective analysis suggests an association between increased doses of opioids during the initial 96 h postoperative period with a higher recurrence rate of NSCLC within 5 yr.

Original languageEnglish (US)
Pages (from-to)i88-i94
JournalBritish journal of anaesthesia
Issue numberSUPPL. 1
StatePublished - 2014
Externally publishedYes


  • analgesics opioid
  • carcinoma non-small-cell lung
  • killer cells natural
  • pain postoperative
  • recurrence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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