Key result
Thoracic epidural analgesia combined with general anaesthesia significantly reduced 36-month mortality to 16.9% compared to 28% with general anaesthesia alone in elective colon cancer surgery.
Why the study?
Basic science data suggest regional anaesthesia reduces perioperative stress levels, potentially lowering complications and cancer relapse, but clinical outcome data in colon cancer surgery were needed.
Does thoracic epidural analgesia added to general anesthesia reduce mortality in patients undergoing open colon cancer surgery?
Cohort (n=215)
No
Does thoracic epidural analgesia added to general anesthesia reduce mortality in patients undergoing open colon cancer surgery?
Absolute Event Rate: 16.9% vs 28%
p-value: p=<0.05
Perioperative use of thoracic epidural analgesia in open colon cancer surgery is associated with reduced 36-month mortality, particularly in patients over 70 years of age.
May be associated with lower mortality after open colon cancer surgery; leaves open causality and requires randomized confirmation.
Background: Colorectal cancer is a major cause of death in the industrial world. The mortality and morbidity rates depend on the incidence of postoperative complications and cancer recurrence. Data from basic science support the view that regional anaesthesia reduces perioperative stress levels, potentially resulting in a lower risk of complications and cancer relapse. Methods: We compared short and long-term outcome data in 215 patients who underwent open colon cancer surgery by the same surgeon and the same oncologist. 83 patients received general anesthesia plus thoracic epidural analgesia (EPI group) and 132 patients received general anaesthesia alone (GA group). Oncological data from a state-wide follow-up database were included. The effects of different perioperative anaesthetic techniques on patients’ short and long-term outcome (36 month) were statistically analysed (Pearson’s chi-squared test, Student’s t-test, Wilcoxon rank sum test) as appropriate. A Kaplan Meyer Analysis for survival was performed and analysed by Wilcoxon rank sum test. Results: With the exception of a significantly higher prevalence of arterial hypertension in the EPI group in comparison with the GA group, there were no differences in demographic, tumour staging data and cancer recurrence rates between the groups. However, mortality rates were significantly different between the groups. 37 of 132 GA patients (28%) died within 36 months, in comparison with 14 of 83 EPI patients (16.9%, P < 0.05). Patients over the age of 70 in particular significantly benefited from perioperative epidural analgesia and had a significantly better survival compared with patients without perioperative epidural analgesia (p<0.05). Discussion: Perioperative use of epidural analgesia reduces the 36-month postoperative mortality rate. This effect may be due to systemic effects of local anaesthetics or to a reduced stress response caused by the thoracic epidural analgesia itself.
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Moormann et al. (2019) conducted a cohort in Colon cancer (n=215). General anaesthesia combined with thoracic epidural analgesia vs. General anaesthesia alone was evaluated on 36-month mortality (p=<0.05). Thoracic epidural analgesia combined with general anaesthesia significantly reduced 36-month mortality to 16.9% compared to 28% with general anaesthesia alone in elective colon cancer surgery.