title: Major abdominal surgery for cancer: does epidural analgesia have a long-term effect on recurrence-free and overall survival?
abstract: BACKGROUND
  Retrospective studies have suggested that regional analgesia combined with general anaesthesia could decrease cancer recurrence. The purpose of this study was to assess the influence of regional analgesia on recurrence-free (RFS) and overall survival in patients undergoing major intra-abdominal surgery for cancer.
  
  
  METHODS
  Patients previously included in a prospective randomized study comparing two postoperative techniques of analgesia were retrospectively studied. The EP group received general anaesthesia with bupivacaine thoracic epidural analgesia and the SC group received general anaesthesia with fentanyl followed by continuous subcutaneous morphine.
  
  
  RESULTS
  One hundred and thirty-two patients were analyzed (63 and 69 in SC and EP group, respectively) with a 17-year-median follow-up. After 5 years, RFS was 43% [95% CI: 32%-55%] in EP group and 24% [95% CI: 15%-36%] in SC group, but the difference did not reach statistical significance for RFS nor for overall survival (P=0.10 and 0.16 respectively). Using multivariable analysis over the whole follow-up period, the type of analgesia was not a statistically significant predictive factor for RFS (EP/SC, HR=1.3 [95% CI: 0.8-2.0%]). The anaesthesia effect changed moderately over the follow-up and HR for overall survival (EP/SC) reached statistical significance after 5, 6 and 8 years.
  
  
  CONCLUSIONS
  Despite a trend in favour of the epidural, this retrospective review of patients included in a previous randomized study failed to demonstrate a statistically significant association between the perioperative analgesia and RFS after abdominal surgery for cancer. The duration of follow-up may have an impact on the analgesia effect on survival.
authors.affiliation: Department of Anesthesia, Institut Gustave-Roussy, Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Binczak
authors.forename: E
authors.initials: E
authors.lastname: Tournay
authors.forename: V
authors.initials: V
authors.lastname: Billard
authors.forename: A
authors.initials: A
authors.lastname: Rey
authors.forename: C
authors.initials: C
authors.lastname: Jayr
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002045:Bupivacaine; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy; D007249:Inflammation; D055104:Infusions, Subcutaneous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018365:Neoplasm, Residual; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D013312:Stress, Physiological
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D009294:Narcotics; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine