A Comparison of Epidural Analgesia and Traditional Pain Management Effects on Survival and Cancer Recurrence after Colectomy

Cummings, Kenneth C.; Xu, Fang; Cummings, Linda C.; Cooper, Gregory S.

doi:10.1097/aln.0b013e31824674f6

Cited by 146 publications

(104 citation statements)

References 46 publications

(37 reference statements)

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“…Although, the results of this meta-analysis are in line with previously published studies indicating an association between the use of epidural anesthesia and/or analgesia and improved shortand long-term OS; a recent study suggest in fact the opposite [16,18,20]. It has been suggested that regional anesthesia might improve the shortterm survival of patients by reducing pulmonary complications, decreasing deep venous thrombosis/pulmonary embolism and lowering rate blood transfusions; however, it remains less clear why the use of that anesthesia technique might reduce long-term mortality [16,20,[26][27].…”

Section: Discussionsupporting

confidence: 89%

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

et al. 2015

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Aims:To determine whether the use neuraxial anesthesia/analgesia is associated with longer biochemical recurrence-free survival (BRFS) and overall survival (OS) after radical prostatectomy. Methods: Ten studies were included in the meta-analysis. A random-effects model was used to estimate the hazard ratios (HRs). Results: The HR for BRFS was 1.02 (95% CI: 0.91-1.15) for all studies and 1.08 (95% CI: 0.91-1.15) for those that included propensity score matching. For OS, the HR across all studies was 0.91 (95% CI: 0.7-1.15) and 0.81 (95% CI: 0.68-0.96; p = 0.016) for those reporting propensity score matching. Conclusion: The anesthetic technique used during oncologic prostatectomy surgery is not associated with longer BRFS. By contrast, the use of regional analgesia appears to improve OS. KEYWORDS• biochemical recurrence-free survivalProstate cancer is the most common malignancy and the second leading cause of cancer death in males [1]. Radical prostatectomy (RP) has been shown to decrease mortality and is the treatment of choice in many patients with localized cancer [2]. However, ∼25% of patients still develop local recurrence or distant metastasis after primary tumor resection [3]. Recurrences are related to tumor stage, Gleason score, lymph node stage, surgical margin status and preoperative serum prostate-specific antigen level [4,5]. Practice points• Regional anesthesia/analgesia has sparing opioid effects.• Local anesthetics have anti-inflammatory and immune protective effects.• Both, sparing opioid and anti-inflammatory effects have been proposed to be the mechanisms by which regional anesthesia might prolong the survival of cancer patients.• Regional anesthesia/analgesia has shown to reduce cancer recurrence in some retrospective studies but not in other similar clinical reports.• The findings of this study do not support the association between regional anesthesia/analgesia and improved recurrence-free survival after radical prostatectomy.• Regional anesthesia/analgesia is associated with a better overall survival after radical prostatectomy.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionsupporting

confidence: 89%

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

et al. 2015

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“…This approach may have led to LC underdetection. Of note, a recent analysis of SEER-Medicare data including cases diagnosed through 2005 evaluating outcomes after colorectal cancer resection found that laparoscopic cases comprised < 2% of cases [32]. Second, the unvalidated blood pints furnished variable may be undercoded and might not correlate with ICD-9-CM blood transfusion procedure codes [33].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open colectomy for colon cancer in an older population: a cohort study

2012

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BackgroundLaparoscopic colectomy for colon cancer has been compared with open colectomy in randomized controlled trials, but these studies may not be generalizable because of strict enrollment and exclusion criteria which may explicitly or inadvertently exclude older individuals due to associated comorbidities. Previous studies of older patients undergoing laparoscopic colectomy have generally focused on short-term outcomes. The goals of this cohort study were to identify predictors of laparoscopic colectomy in an older population in the United States and to compare short-term and long-term outcomes.MethodsPatients aged 65 years or older with incident colorectal cancer diagnosed 1996-2002 who underwent colectomy within 6 months of cancer diagnosis were identified from the linked Surveillance, Epidemiology, and End Results-Medicare database. Laparoscopic and open colectomy patients were compared with respect to length of stay, blood transfusion requirements, intensive care unit monitoring, complications, 30-day mortality, and long-term survival. We adjusted for potential selection bias in surgical approach with propensity score matching.ResultsLaparoscopic colectomy cases were associated with left-sided tumors; areas with higher population density, income, and education level; areas in the western United States; and National Cancer Institute-designated cancer centers. Laparoscopic colectomy cases had shorter length of stay and less intensive care unit monitoring. Although laparoscopic colectomy patients (n = 424) had fewer complications (21.5% versus 26.3%), lower 30-day mortality (3.3% versus 5.8%), and longer median survival (6.6 versus 4.8 years) compared with open colectomy patients (n = 27,012), after propensity score matching these differences disappeared.ConclusionsIn this older population, laparoscopic colectomy practice patterns were associated with factors which likely correlate with tertiary referral centers. Although short-term and long-term survival are comparable, laparoscopic colectomy offers shorter hospitalizations and less intensive care.

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“…10,11 The primary outcome of the study was time to discontinuation of opioids. This was defined as a period of thirty days without filling a prescription for an opioid after discharge from the hospital.…”

Section: Methodsmentioning

confidence: 99%

Impact of Perioperative Epidural Placement on Postdischarge Opioid Use in Patients Undergoing Abdominal Surgery

Ladha

Patorno

et al. 2016

Anesthesiology

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Background Opioids play a crucial role in providing analgesia throughout the perioperative period; however, patients may become persistent users of these medications months after surgery. Epidurals have been posited to prevent the development of persistent pain, but there are little data on the effect of epidurals on persistent opioid use. Methods This study was conducted using a claims database of a large, nationwide commercial health insurer. Opioid-naive patients who underwent open abdominal surgery from January 2004 to December 2013 were included in the study. Propensity scores for epidural placement were calculated accounting for demographic characteristics, resource utilization, and comorbid conditions (including medical, psychiatric, and pain conditions). Time-to-event analysis was used with the primary outcome defined as 30 days without filling an opioid prescription after discharge. In addition, total morphine equivalents dispensed within 90 days of discharge were also calculated for each patient. Results A total of 6,432 patients were included in the final propensity score–matched cohort. The Cox proportional hazards ratio was 0.96 (95% CI, 0.91 to 1.01; P = 0.0910) for the relation between epidural placement and time till a 30-day gap without filling an opioid prescription. There was no difference in the total morphine equivalents dispensed within 90 days of discharge between the groups (P = 0.7670). Conclusions Epidural placement was not protective against persistent opioid use in a large cohort of opioid-naive patients undergoing abdominal surgery. This finding does not detract from the other potential benefits of epidural placement. More research is needed to understand the mechanism of persistent opioid use after surgery and its prevention.

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A Comparison of Epidural Analgesia and Traditional Pain Management Effects on Survival and Cancer Recurrence after Colectomy

Abstract: This large cohort study found that epidural use is associated with improved survival in patients with nonmetastatic colorectal cancer undergoing resection but does not support an association between epidural use and decreased cancer recurrence.

Cited by 146 publications

References 46 publications

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

Regional Anesthesia/Analgesia and the Risk of Cancer Recurrence and Mortality After Prostatectomy: A Meta-Analysis

Laparoscopic versus open colectomy for colon cancer in an older population: a cohort study

Impact of Perioperative Epidural Placement on Postdischarge Opioid Use in Patients Undergoing Abdominal Surgery

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