Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Objectives Whether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer. Design Retrospective cohort study. Setting A single-medical centre in Taiwan. Participants Patients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014. Primary and secondary outcome measures Primary outcome was postoperative recurrence-free survival and secondary outcome was overall survival. Results A total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion. Conclusions No definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.

[1]  S. Tai,et al.  Stage-dependent angiopoietin-Tie2 and nitric oxide signaling of erythrocytes in response to surgical trauma in head and neck cancer , 2020, World Journal of Surgical Oncology.

[2]  M. Tsou,et al.  The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection , 2020, Anaesthesia.

[3]  Hsiao-Huang Chang,et al.  High‐dose nitroglycerin administered during rewarming preserves erythrocyte deformability in cardiac surgery with cardiopulmonary bypass , 2020, Microcirculation.

[4]  E. Mascha,et al.  Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial , 2019, The Lancet.

[5]  M. Tsou,et al.  Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan , 2019, BMJ Open.

[6]  M. Büchler,et al.  Peridural analgesia does not impact survival in patients after colon cancer resection: a retrospective propensity score-adjusted analysis , 2019, International Journal of Colorectal Disease.

[7]  Wen‐Kuei Chang,et al.  Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection? , 2019, Medicine.

[8]  T. Quinn,et al.  Can anesthesiologists affect cancer outcomes? , 2019, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[9]  D. Sessler,et al.  Anesthesia and Cancer Recurrence: Context for Divergent Study Outcomes. , 2018, Anesthesiology.

[10]  Hsiu-Hsi Chen,et al.  The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients , 2018, Scientific Reports.

[11]  Hsiu-Hsi Chen,et al.  The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study , 2018, PloS one.

[12]  H. Rittner,et al.  Opioids and the immune system – friend or foe , 2018, British journal of pharmacology.

[13]  A. Pockley,et al.  Influence of opioids on immune function in patients with cancer pain: from bench to bedside , 2018, British journal of pharmacology.

[14]  Hsiu-Hsi Chen,et al.  Intraoperative Fentanyl Consumption Does Not Impact Cancer Recurrence or Overall Survival after Curative Colorectal Cancer Resection , 2017, Scientific Reports.

[15]  W. Mesker,et al.  Differences between colon and rectal cancer in complications, short-term survival and recurrences , 2016, International Journal of Colorectal Disease.

[16]  J. Wind,et al.  Symptomatic and Asymptomatic Colon Cancer Recurrence: A Multicenter Cohort Study , 2016, The Annals of Family Medicine.

[17]  H. Lenz,et al.  Primary tumor location as a prognostic factor in metastatic colorectal cancer. , 2015, Journal of the National Cancer Institute.

[18]  E. Jewell,et al.  Regional Versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? , 2015, Anesthesia and analgesia.

[19]  J. Coffey,et al.  Lymphovascular Invasion: A Comprehensive Appraisal in Colon and Rectal Adenocarcinoma , 2015, Diseases of the colon and rectum.

[20]  V. Lemmens,et al.  Epidural analgesia associated with better survival in colon cancer , 2015, International Journal of Colorectal Disease.

[21]  R. Röhrig,et al.  Peridural Analgesia May Affect Long-term Survival in Patients With Colorectal Cancer After Surgery (PACO-RAS-Study): An Analysis of a Cancer Registry , 2013, Annals of surgery.

[22]  H. Friess,et al.  Mucinous and Signet-Ring Cell Colorectal Cancers Differ from Classical Adenocarcinomas in Tumor Biology and Prognosis , 2013, Annals of surgery.

[23]  W. Law,et al.  Laparoscopic surgery for colorectal cancer. , 2012, British medical bulletin.

[24]  G. Cooper,et al.  A Comparison of Epidural Analgesia and Traditional Pain Management Effects on Survival and Cancer Recurrence after Colectomy: A Population-based Study , 2012, Anesthesiology.

[25]  M. Fredriksson,et al.  Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden. , 2011, British journal of anaesthesia.

[26]  M. Filipovic,et al.  Epidural Analgesia in Open Resection of Colorectal Cancer: Is there a Clinical Benefit? A Retrospective Study on 1,470 Patients , 2011, Journal of Gastrointestinal Surgery.

[27]  P. Austin.  An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies , 2011, Multivariate behavioral research.

[28]  S. Sukumar*,et al.  C-stage in colon cancer: implications of carcinoembryonic antigen biomarker in staging, prognosis, and management. , 2011, Journal of the National Cancer Institute.

[29]  P. Myles,et al.  Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial , 2011, BMJ : British Medical Journal.

[30]  J. Moss,et al.  Effect of perioperative opioids on cancer recurrence: a hypothesis. , 2010, Future oncology.

[31]  F. Carli,et al.  Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways , 2010, Regional Anesthesia & Pain Medicine.

[32]  M. Pollheimer,et al.  Perineural invasion: correlation with aggressive phenotype and independent prognostic variable in both colon and rectum cancer. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[33]  E. Mascha,et al.  Association between Epidural Analgesia and Cancer Recurrence after Colorectal Cancer Surgery , 2010, Anesthesiology.

[34]  M. Tableman,et al.  Long-Term Survival After Colon Cancer Surgery: A Variation Associated with Choice of Anesthesia , 2007, Anesthesia and analgesia.

[35]  D. Sargent,et al.  Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[36]  M. Pescatori,et al.  Perioperative blood transfusions and recurrence of colorectal cancer , 2006 .

[37]  M E Hammond,et al.  Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. , 2000, Archives of pathology & laboratory medicine.

[38]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[39]  R J Salmon,et al.  [Prognostic factors of colorectal cancer]. , 1989, Pathologie-biologie.