The Effect of Intraoperative Fentanyl Consumption on Prognosis of Colorectal Liver Metastasis treated by Simultaneous Resection: A Propensity Score Matching Analysis

Abstract

Background: No previous studies have reported the effect of intraoperative opioid consumption in colorectal liver metastasis (CRLM). Methods: Medical records of patients who received simultaneous resection of CRLM were retrospectively reviewed. Patients with epidural anesthesia, intraoperative morphine, or intraoperative oxycodone were excluded. Patients were separated into high- and low-dose groups by median intraoperative equianalgesic fentanyl dose. Short-term outcomes, progression-free surcical (PFS) and overall survival (OS) were compared between groups before and after 1:1 propensity score matching (PSM). Univariable and multivariable Cox regression analysis were performed to identify independent predictors of survival. Results: The final study population included 343 patients. Patients were separated into the low dose group (n=172) and the high dose group (n=171) by median intraoperative equianalgesic fentanyl dose (8.33 μg/kg). After PSM, 55 patients in the low dose group were matched to 55 patients in the high dose group and the baseline characteristics of the two groups were balanced. The two groups had no statistically significance difference in severity and categories of postoperative complications before and after PSM. Before PSM, the two groups had similar PFS (median 10.2 vs. 12.4 months, P =0.54) and OS (median 59.0 vs. 58.3 months, P =0.76). Univariate and multivariate Cox regression analyses revealed no statistically significant association between intraoperative equianalgesic fentanyl and PFS (multivariate HR=0.852, 95% CI 0.655-1.11, P =0.235) and OS (multivariate HR=1, 95% CI 0.68-1.49, P = 0.981). After PSM, the two groups also had similar PFS (median 9.2 vs. 10.7 months, P =0.98) and OS (median 51.0 vs. 46.0 months, P =0.39). Univariate and multivariate Cox regression analyses revealed no statistically significant association between intraoperative equianalgesic fentanyl and PFS (multivariate HR=1.05, 95% CI 0.632-1.73, P =0.861) and OS (multivariate HR=1.74, 95% CI 0.892-3.38, P = 0.105). Conclusion: Intraoperative opioids consumption was not correlated with outcomes of CRLM patients treated with simultaneous resection.

Anaesthesia and cancer recurrence: the influence of perioperative anaesthetic technique on cancer recurrence after surgery

“…Hepatocellular cancer patients with higher postoperative morphine requirements had worse overall survival but similar recurrence rates compared with patients receiving lower postoperative opioid doses [15], and among 110 propensity score-matched colorectal cancer patients with liver metastases, intra-operative opioid was not associated with a difference in cancer outcomes [16]. RCT evidence of opioid effects on cancer outcomes is limited – one RCT of 146 patients showed no difference in biochemical prostate cancer recurrence following opioid-based or opioid-free anaesthesia [17 ▪ ].…”