title: 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.
abstract: BACKGROUND
  There is some evidence that epidural analgesia (EDA) reduces tumour recurrence after breast and prostatic cancer surgery. We assessed whether EDA reduces long-term mortality after colorectal cancer surgery.
  
  
  METHODS
  All patients having colorectal cancer surgery between January 2004 and January 2008 at Linköping and Örebro were included. Exclusion criteria were: emergency operations, laparoscopic-assisted colorectal resection, and stage 4 cancer. Statistical information was obtained from the Swedish National Register for Deaths. Patients were analysed in two groups: EDA group or patient-controlled analgesia (PCA group) as the primary method of analgesia.
  
  
  RESULTS
  A total of 655 patients could be included. All-cause mortality for colorectal cancer (stages 1-3) was 22.7% (colon: 20%, rectal: 26%) after 1-5 yr of surgery. Multivariate regression analysis identified the following statistically significant factors for death after colon cancer (P<0.05): age (>72 yr) and cancer stage 3 (compared with stage 1). A similar model for rectal cancer found that age (>72 yr) and the use of PCA rather than EDA and cancer stages 2 and 3 (compared with stage 1) were associated with a higher risk for death. No significant risk of death was found for colon cancer when comparing EDA with PCA (P=0.23), but a significantly increased risk of death was seen after rectal cancer when PCA was used compared with EDA (P=0.049) [hazards ratio: 0.52 (0.27-1.00)].
  
  
  CONCLUSIONS
  We found a reduction in all-cause mortality after rectal but not colon cancer in patients having EDA compared with PCA technique.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Orebro, Sweden. anil.gupta@orebroll.se
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Björnsson
authors.forename: M
authors.initials: M
authors.lastname: Fredriksson
authors.forename: O
authors.initials: O
authors.lastname: Hallböök
authors.forename: C
authors.initials: C
authors.lastname: Eintrei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000767:Anesthesia, Epidural; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000517:prevention & control*; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult