title: The relationship between neuraxial anesthesia and advanced ovarian cancer-related outcomes in the Chilean population.
abstract: BACKGROUND
  Mixed evidence has been published relating the use of regional anesthesia during oncologic surgery to a decrease in time to cancer recurrence and improvement in overall survival. We investigated whether the use of epidural anesthesia, in addition to general analgesia during and/or after surgical removal of advanced ovarian cancer, has an impact on time to recurrence and overall survival.
  
  
  METHODS
  Patients were identified from a prospective clinical registry. Eighty patients with advanced ovarian cancer (International Federation of Gynecologists and Obstetricians, stage IIIC and IV) undergoing surgery between January 2000 and March 2011 were studied. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the time to recurrence and overall survival of patients who did and did not receive epidural anesthesia and/or analgesia (EA), after controlling for selection bias.
  
  
  RESULTS
  The median time to recurrence was 1.6 and 0.9 years for the EA and no EA groups, respectively (P = 0.02). After PS matching, the median time to recurrence was 1.6 and 1.4 years for the EA and no EA groups, respectively (P = 0.30). Similarly, PS weighting did not demonstrate an improvement in time to recurrence with the use of EA. Using a Cox proportional hazards model in the PS-matched sample, the estimated hazard ratio for EA exposure (0.72; 95% confidence interval [CI], 0.40-1.33) did not change substantially after adjusting for chemotherapy (0.73; 95% CI, 0.40-1.31). Similar results were obtained using PS weighting. The median survival time was 3.3 and 1.9 years for the EA and no EA groups, respectively (P = 0.01). After PS matching, the median survival time was 3.3 and 2.7 years for the EA and no EA groups, respectively (P = 0.37). Similarly, PS weighting did not demonstrate an improved survival with the use of EA. The estimated hazard ratio (0.74; 95% CI, 0.36-1.49) in the PS matched sample did not change substantially after adjusting for chemotherapy, with similar results when PS weighting was applied.
  
  
  CONCLUSIONS
  After PS matching and weighting, we found no benefit in overall survival or time to recurrence in patients with advanced stages (International Federation of Gynecologists and Obstetricians IIIC and IV) of ovarian cancer after the use of EA during and after tumor debulking surgery.
authors.affiliation: From the Departamento de Anestesiología, Escuela de Medicina and División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; and Division of Biostatistics, School of Public Health, Columbia University, New York, New York.
authors.forename: Hector J
authors.initials: HJ
authors.lastname: Lacassie
authors.forename: Jaime
authors.initials: J
authors.lastname: Cartagena
authors.forename: Jorge
authors.initials: J
authors.lastname: Brañes
authors.forename: Melissa
authors.initials: M
authors.lastname: Assel
authors.forename: Ghislaine C
authors.initials: GC
authors.lastname: Echevarría
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002677:Chile / Q000453:epidemiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy; D057216:Propensity Score; D016016:Proportional Hazards Models; D013534:Survival; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents; D020910:Ketorolac