Epidural analgesia does not impact recurrence or mortality in patients after rectal cancer resection

Abstract

The relationship between epidural analgesia and rectal cancer outcome is not fully clarified. We aimed to investigate the putative effect of epidural analgesia on the risks of recurrence and mortality after rectal tumour resection. In this monocentric cohort study, we consecutively enrolled patients with stage I–III rectal cancer who underwent tumour resection from 2005 to 2014. Patients received epidural analgesia or intravenous opioid-based analgesia for postoperative pain control. Primary endpoint was first cancer recurrence. Secondary endpoints were all-cause mortality and cancer-specific mortality. We collected 1282 patients in the inverse probability of treatment weighting analyses, and 237 (18.5%) used epidurals. Follow-up interval was median 46.1 months. Weighted Cox regression analysis showed the association between epidural analgesia and recurrence-free survival was non-significant (adjusted hazard ratio [HR] 0.941, 95% CI 0.791–1.119, p = 0.491). Similarly, the association between epidural analgesia and overall survival (HR 0.997, 95% CI 0.775–1.283, p = 0.984) or cancer-specific survival (HR 1.113, 95% CI 0.826–1.501, p = 0.482) was non-significant either. For sensitivity tests, quintile stratification and stepwise forward model selection analyses showed similar results. We did not find a significant association between epidural analgesia and risk of recurrence, all-cause mortality, or cancer-specific mortality in patients with rectal cancer undergoing tumour resection.

Impact of general or regional anaesthesia on recurrence of colorectal cancer after surgery: Systematic review

“…In patients with rectal cancer resection (stage I–III), Wu et al . [ 34 ] concluded that postoperative EA also did not improve recurrence or mortality, with a follow-up duration of 46.1 months, when compared to opioid analgesia. A retrospective study by Exadaktylos et al .…”

A predictive model incorporating inflammation markers for high-grade surgical complications following liver resection for hepatocellular carcinoma

“…49 Second, given that intraoperative blood loss and perioperative blood transfusion were linked to greater mortality rates after cancer surgery, strategies aimed at reducing blood loss and the use of blood transfusion during liver resection should be further developed, especially in cirrhotic liver. [33][34][35]50 Third, high-risk patients may need close observation and intensive care for possible bile leakage, infection, and organ failure after surgery. More studies are required to validate the efficacy of our model in reducing complications after liver resection.…”

“…Surgical and anesthetic covariates were extent of hepatectomy (>2 Couinaud liver segments or not), R0 resection, laparoscopic or robotic surgery, epidural anesthesia, intraoperative blood loss and transfusion, and anesthesia time. 22,30–35…”

Effects of Perioperative Epidural Analgesia on Cancer Recurrence and Survival

“…However, higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage, and pathological lymphovascular invasion were independent risk factors for cancer recurrence and death in these patients ( 10 ). In patients with rectal cancer resection (stage I-III), postoperative EA also did not improve recurrence or mortality with a follow-up duration of 46.1 months when compared to opioids analgesia ( 11 ). For patients with stage IV colorectal cancer, one study involving 999 patients showed perioperative EA was not associated with better progression-free or overall survival after surgeries with 17.5 months follow-up ( 12 ).…”