Beneficial Effects of thoracic epidural anaesthesia on mortality after elective surgery for colon cancer: a survey of 215 consecutive patients

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: In 215 patients underwent open colon cancer surgery, carried out by the same visceral surgeon and the same oncologist we compared short and long-term outcome data for 83 patients with general anaesthesia plus thoracic epidural analgesia (EPI group) and for 132 patients with 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 (Kaplan Meyer Curve, Pearson’s chi-squared test, Student’s t-test, and the Wilcoxon rank sum test, as appropriate). 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. Conclusions: Patients with colon cancer over the age of 70 in particular significantly benefited from perioperative epidural analgesia and had a longer survival time in comparison with patients without perioperative epidural analgesia. (ISRCTN10994336, retrospective registered 07/06/2019)