title: Epidural analgesia in open resection of colorectal cancer: is there a clinical benefit? a retrospective study on 1,470 patients.
abstract: BACKGROUND
  Epidural analgesia (EA) is effective for postoperative pain relief and results in an earlier recovery from postoperative paralytic ileus. This study evaluated the influence of epidural analgesia on the postoperative 30-day mortality and morbidity after open colorectal cancer resection.
  
  
  METHODS
  A retrospective observational study was performed at a single, tertiary hospital. All patients with an open colorectal cancer surgery between 1991 and 2008 were identified from the hospital database.
  
  
  RESULTS
  Of the 1,470 patients included in the study, 838 (57.0%) received an EA. Mortality was lower after EA (1.5% vs. 5.7%, p < 0.001). Risk of pneumonia was reduced after EA (odds ratio (OR), 0.45; 95% confidence interval (CI), 0.28-0.74; p = 0.001), but not the risk of anastomotic leakage (OR, 1.18; 95% CI, 0.76-1.81; p = 0.465) or surgical site infections (OR, 1.09; 95% CI, 0.74-1.60; p = 0.663). A subgroup analysis of 427 patients operated on after 2002 (reflecting improved perioperative management) yielded similar results. However, no significant reduction in mortality was observed in the subgroup analysis.
  
  
  CONCLUSIONS
  For patients with open colorectal cancer surgery, the application of EA leads to a reduction in pneumonia. Although this is only a retrospective study, it strongly supports the use of EA.
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffen
authors.forename: Andreas
authors.initials: A
authors.lastname: Lüthi
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beutner
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Müller
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000401:mortality*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D057868:Anastomotic Leak / Q000453:epidemiology; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine