Peridural Anesthesia and Cancer-Related Survival after Surgery for Pancreatic Cancer—A Retrospective Cohort Study

Abstract

Background: In patients with prostatic and breast cancer the application of peridural anesthesia (PDA) showed a beneficial effect on prognosis. This was explained by reduced requirements for general anesthetics and perioperative opioids as well as a lower perioperative stress level. The impact of PDA in patients with more aggressive types of cancer has not been completely elucidated. Here, we analyzed the prognostic influence of PDA on overall survival after surgery as primary in patients that underwent radical resection of pancreatic adenocarcinoma. Methods: Records of 98 consecutive patients were reviewed. In 70 of these cases PDA was applied. Patient characteristics such as demographics, TNM stage, and operative data were retrospectively collected from medical records and analyzed. Survival data were analyzed by Cox’s proportional hazard regression model. Results: Overall, no significant prognostic influence of PDA on recurrence or overall survival (p = 0.762, Hazard Ratio [HR] 0.884, 95% confidence interval [CI] 0.398–1.961) was found. However, there was a trend towards a longer overall survival (p = 0.069, HR 0.394, 95% CI 0.144–1.078) associated with PDA in a subgroup of patients with better differentiation of pancreatic adenocarcinoma. Conclusion: The observation of longer survival associated with PDA in our subgroup of patients with better-differentiated pancreatic carcinomas is in line with previous reports on various other less aggressive tumor entities. Our results indicate that PDA might improve the oncological outcome of patients with pancreatic adenocarcinoma.

Effects of Perioperative Epidural Analgesia on Cancer Recurrence and Survival

“…Whereas, Alexander et al. reported no association between EA use and recurrence or overall survival in patients underwent radical resection of pancreatic adenocarcinoma, although subgroup analysis revealed a trend towards a longer overall survival associated with perioperative EA in patients with better differentiation of pancreatic adenocarcinoma ( 48 ). The concentration of LAs may also influence the effects of EA on the oncological outcomes in patients after pancreatic surgery.…”

Trial watch: local anesthetics in cancer therapy

“…11 patients with high concentration of LA (0.375–0.5%) and 96 patients with low concentration (0.15–0.25%) High concentration of ropivacaine improved OS ( p = .04) and was an independent good prognostic factor (HR = 0.65, 95%CI[0.44–0.94]; p = .03) 154 Pancreas Bupivacaine (epidural) Two hundred and fifty-two patients included (n = 88 epidural; n = 164 without epidural) No association with greater recurrence ( p = .87) or all-cause mortality ( p = .85). 175 Pancreas Ropivacaine (peridural) Ninety-eight patients included (70 peridural) No benefits in recurrence or OS 176 Prostate Bupivacaine (epidural) One hundred and forty-eight patients involved (67 epidural) Do not reduce the risk of progression. Do not improve survival.…”

Pancreatic Cancer and Microenvironments: Implications of Anesthesia

“…The multivariable analysis showed that intraoperative administration of lidocaine improved overall survival (HR = 0.616; 95% CI, 0.290–0.783; P = 0.013) in patients undergoing pancreatectomy [ 12 ]. A clinical study reported that peridural anesthesia with ropivacaine may improve the oncological outcome of PC patients [ 72 ]. Chen et al also reported that intraoperative epidural infusion with a high concentration of ropivacaine was associated with improved overall survival in PC patients undergoing pancreatectomy [ 70 ].…”