title: Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial.
abstract: OBJECTIVE
  To compare long term recurrence of cancer and survival of patients having major abdominal surgery for cancer.
  
  
  METHODS
  Long term follow-up of prospective randomised controlled clinical trial in which patients were randomly assigned to receive general anaesthesia with or without epidural block for at least three postoperative days. Setting 23 hospitals in Australia, New Zealand, and Asia.
  
  
  METHODS
  503 adult patients who had potentially curative surgery for cancer.
  
  
  METHODS
  Cancer-free survival (analysis was by intention to treat).
  
  
  RESULTS
  Long term follow-up data were available for 94% (n=446) of eligible participants. The median time to recurrence of cancer or death was 2.8 (95% confidence interval 0.7 to 8.7) years in the control group and 2.6 (0.7 to 8.7) years in the epidural group (P=0.61). Recurrence-free survival was similar in both epidural and control groups (hazard ratio 0.95, 95% confidence interval 0.76 to 1.17; P=0.61).
  
  
  CONCLUSIONS
  Use of epidural block in abdominal surgery for cancer is not associated with improved cancer-free survival.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12607000637448.
authors: Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia. p.myles@alfred.org.au
authors: Paul S
authors: PS
authors: Myles
authors: Philip
authors: P
authors: Peyton
authors: Brendan
authors: B
authors: Silbert
authors: Jennifer
authors: J
authors: Hunt
authors: John R A
authors: JR
authors: Rigg
authors: Daniel I
authors: DI
authors: Sessler
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000401:mortality*; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*