title: Peridural analgesia may affect long-term survival in patients with colorectal cancer after surgery (PACO-RAS-Study): an analysis of a cancer registry.
abstract: OBJECTIVE
  To determine the effect of peridural analgesia on long-term survival in patients who underwent surgical treatment of colorectal carcinoma.
  
  
  BACKGROUND
  Clinical and animal studies suggest a potential benefit of peridural analgesia on morbidity and mortality after cancer surgery. The effect of peridural analgesia on long-term outcome after surgery for colorectal cancer remains undefined.
  
  
  METHODS
  From 2003 to 2009, there were 749 patients who underwent surgery for colorectal carcinoma under general anesthesia with or without peridural analgesia. Clinical data were reviewed retrospectively and analyzed with multivariate analysis and Kaplan-Meier plots.
  
  
  RESULTS
  There were 442 patients who received peridural analgesia and 307 patients who did not receive peridural analgesia. A substantial survival benefit was observed in patients who received peridural analgesia (5-year survival rate: peridural analgesia, 62%; no peridural analgesia, 54%; P < 0.02). The hazard rate for death was decreased by 27% in patients who received peridural analgesia. When peridural analgesia was included simultaneously in a Cox model with the confounding factors age, American Society of Anesthesiologists classification, and stage, there was a significant survival benefit in patients who received peridural analgesia. In patients with America Society of Anesthesiologists classification 3 to 4, there was significantly greater survival with peridural analgesia than without peridural analgesia (P < 0.009).
  
  
  CONCLUSIONS
  Peridural analgesia may improve survival in patients underwent surgery for colorectal carcinoma. The survival benefit with peridural analgesia was greater in patients who had greater medical morbidity.
authors: *Department of General, Visceral, Thoracic and Transplant Surgery †Department of Anesthesiology, Intensive Care and Pain Medicine ‡Tumor Center, Justus-Liebig-University of Giessen and Marburg, Campus Giessen, Germany §Department of Anesthesiology, Intensive Care and Pain Medicine, Klinikum Hanau GmbH, Hanau, Germany.
authors: Julia P N
authors: JP
authors: Holler
authors: Janko
authors: J
authors: Ahlbrandt
authors: Ernst
authors: E
authors: Burkhardt
authors: Marco
authors: M
authors: Gruss
authors: Rainer
authors: R
authors: Röhrig
authors: Julia
authors: J
authors: Knapheide
authors: Andreas
authors: A
authors: Hecker
authors: Winfried
authors: W
authors: Padberg
authors: Markus A
authors: MA
authors: Weigand
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects*; D002277:Carcinoma / Q000401:mortality* / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors