Impact of intraoperative dexmedetomidine on clear cell renal cell carcinoma progression: a retrospective cohort study.

Abstract

Dexmedetomidine, an α-2 adrenoreceptor agonist, is commonly administered during cancer surgery as an adjuvant sedative because of its general anaesthetic agent-sparing effects. We investigated the association between ADRA2 gene expression and dexmedetomidine on oncological outcomes after surgery for clear cell renal cell carcinoma (RCC). We conducted an in silico analysis using a publicly available database and a retrospective study in patients with clear cell RCC. The associations between ADRA2A expression and recurrence-free survival and overall survival were analysed. The same outcomes were investigated in a cohort of patients who underwent partial or total nephrectomy and received dexmedetomidine or not. A propensity score matching strategy was utilised to account for selection bias, and a multivariable analysis was performed to control for variables implicated in survival. Expression of the ADRA2A gene at the tumour level was not associated with recurrence-free survival; however, higher levels of expression were significantly associated with shorter overall survival. A total of 1766 patients with clear cell RCC were included in the retrospective study. Dexmedetomidine administration was not associated with higher rates of recurrence or mortality or with a significant impact on recurrence-free survival or overall survival. Intraoperative administration of dexmedetomidine was not associated with a significant impact on cancer progression and survival. The role of ADRA2A as a prognosis biomarker for clear cell RCC warrants further study.