Head and Neck Cancer
Conditions
Brief summary
In the clinical trial the investigators will observe the impact of regional anesthesia in addition to a general anesthesia on the expression of substance P in patients with unilateral Head or Neck cancer undergoing unilateral Neck Dissection. The investigators will perform an unilateral regional cervical plexus block on the tumor side. The tissue of the tumor side will be analysed by immunohistology, measuring the expression of the Substance P.
Detailed description
Several investigations show that anesthetic procedures, and especially the perioperative regional anesthesia, can have a benefit for patients undergoing tumor surgery.The perioperative regional anesthesia might reduce the immunological response and therefore lower the risk of tumor relapse. Factors that might play a role in tumor relapse are various, so more prospective and randomised trials are necessary to investigate the underlying mechanisms. In a retrospective analysis by Merquiol et al. it was shown that an cervical epidural anesthesia was associated with an extended tumorfree timeline of larynx and hypopharynx carcinoma. Supporting results could be seen in a study by Munoz et al. performing regional anaesthesia in breast cancer patients. Taking all these facts into consideration the investigators believe that performing regional aneasthesia could reduce the relapse of larynx carcinoma. The relapse of carcinoma is believed to be linked to substance P and the neurokinin 1 (NK-1) receptor . It is accepted that an additional regional anesthesia could reduce the impact of substance P to gain a normal immune response in the perioperative setting and to reduce the rate of tumor relapse.
Interventions
DRUGSPRANC Block group
General anaesthesia with Propofol (2mg/kgKG) and Remifentanil (0,1-0,4 µg/kg/min); additional regional anaesthesia (cervical plexus block) with an long acting local anesthetic according to clinical estimation of the treating anesthetist (about 15 ml Ropivacaine 0,75% around the carotid bifurcation, 5 ml Ropivacaine in the region of Erb´s Point of the superficial cervical plexus and 10 ml Ropivacaine at the area of skin incision on the tumor side); unilateral neck dissection.
DRUGSPRANC Control group
General anaesthesia with Propofol (2mg/kgKG) and Remifentanil (0,1-0,4 µg/kg/min); additional regional Patient Control Group (no Intervention planned), general anaesthesia with Propofol (2mg/kgKG) and Remifentanil (0,1-0,4 µg/kg/min); unilateral neck dissection.
Sponsors
Charite University, Berlin, Germany
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients at Charité - Universitaetsmedizin Berlin, Campus Charité Mitte * Primary diagnosis of unilateral head or neck cancer * Resection of Tumor is planned with unilateral neck dissection * Patient did not underwent any therapeutic treatment of the cancer before start of study * Surgical therapy is planned with curative intent
Exclusion criteria
* Allergy to local anesthetics * Coagulation disorders, which can lead to complications in regional anesthesia * Insulin-dependent diabetes mellitus, polyneuropathy * Severe psychiatric disorders * Dementia * Alcohol abuse, Korsakoff syndrome * Medication with immunosuppressants or immune modulantia * Patient under Special Care * Refusal of study participation * Pregnancy and breast feeding period. * Participation in a clinical intervention study, parallel with the study or participation up to 30 days before inclusion * Lack of consent that pseudonomized data of the study may be saved and distributed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Expression of Substance P | 2 years |
Countries
Germany
Outcome results
None listed