title: Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery.
abstract: OBJECTIVE
  Regional anesthesia has been shown to blunt the response to surgical stress and decrease the use of volatile anesthetics and the consumption of opioids, which may reduce immune compromise and potentially delay tumor recurrence. The goal of this study was to find a possible association between intraoperative regional anesthesia and decreased cancer recurrence.
  
  
  METHODS
  Patients who underwent surgery for ovarian cancer between January 1, 2000, and October 1, 2006, were included. Subjects who had optimal surgical debulking (<1.0 cm of remaining tumor) were evaluated for time to tumor recurrence (carcinoantigen 125 >21 U/mL or computed tomography evidence of disease progression) and/or death.
  
  
  RESULTS
  One hundred eighty-two patients were evaluated; 127 did not receive epidural anesthesia/analgesia. Among the 55 who had epidural catheters placed, 26 were used intraoperatively and postoperatively; 29 were used only postoperatively. Cancer recurrence was documented in 121 patients. The median (interquartile range) time to recurrence was 40 (25-52) months. The intraoperative use epidural group had a mean (95% confidence interval) time to recurrence of 73 (56-91) months, which was longer than either the epidural postoperative group 33 (21-45) months (P = 0.002) or the no-epidural group 38 (30-47) months (P = 0.001). The postoperative-only and no-epidural groups were not different (P = 0.92). Intraoperative epidural significantly reduced (hazard ratio, 0.37 [95% confidence interval, 0.19-0.73]) tumor recurrence risk.
  
  
  CONCLUSIONS
  Intraoperative use of epidural anesthesia was associated with an increased time to tumor recurrence after surgery in ovarian cancer patients. This may be a result of preservation of the immune system function.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. g-jr@northwestern.edu
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: de Oliveira
authors.forename: Shireen
authors.initials: S
authors.lastname: Ahmad
authors.forename: Julian C
authors.initials: JC
authors.lastname: Schink
authors.forename: Diljeet K
authors.initials: DK
authors.lastname: Singh
authors.forename: Paul C
authors.initials: PC
authors.lastname: Fitzgerald
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D055502:Secondary Prevention; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome