title: Factors associated with improved survival after resection of pancreatic adenocarcinoma: a multivariable model.
abstract: BACKGROUND
  Several retrospective studies suggest that perioperative care and anesthetic management for cancer resection may influence cancer recurrence or patient survival. Various intraoperative techniques such as paravertebral blocks, decreased opioid use, immunomodulation, and perioperative antiinflammatory administration, have previously been assessed for improved patient survival. The aim of this study was to assess associations between perioperative management and survival in patients undergoing resection of pancreatic adenocarcinoma.
  
  
  METHODS
  Survival data and anesthetic records for 144 patients who had surgical resection of pancreatic adenocarcinoma from 2001 to 2012 were obtained and associations were sought between survival and 19 predefined variables. The authors performed a propensity weighted multivariable statistical analysis using Cox proportional hazards.
  
  
  RESULTS
  Median length of survival was 562 days with 95% confidence interval (471, 680). In a multivariable Cox proportional hazard model of survival, the authors found increased survival in patients who received perioperative epidural analgesia and/or intraoperative dexamethasone. There was a 44% hazard ratio reduction, hazard ratio = 0.56, 95% confidence interval (0.38, 0.87), with dexamethasone. Adjuvant postoperative chemotherapy was associated with longer survival. A decrease in survival was noted in patients who received intraoperative blood transfusions, had poorer histologic grade, and advanced tumor stage.
  
  
  CONCLUSIONS
  The authors report an association between perioperative dexamethasone administration and improved survival in human pancreatic adenocarcinoma patients. An association between use of epidural anesthesia during primary pancreatic cancer surgery and prolonged survival was also observed. Previously identified associations between perioperative blood transfusions and poor tumor histologic grade and decreased survival were confirmed. Further investigations regarding the use of perioperative dexamethasone and neuraxial anesthesia in this patient population are warranted.
authors.affiliation: From the Department of Anesthesiology, University of Utah, Huntsman Cancer Hospital, Salt Lake City, Utah (T.R.C., B.C.); Department of Anesthesiology, University of Utah, Salt Lake City, Utah (N.L.P., D.M.); University of Utah School of Medicine, University of Utah, Salt Lake City, Utah (D.B.T.); and Department of Surgery, University of Utah, Hunstman Cancer Hospital, Salt Lake City, Utah (J.C., S.J.M.).
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Call
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Pace
authors.forename: Datus B
authors.initials: DB
authors.lastname: Thorup
authors.forename: Derric
authors.initials: D
authors.lastname: Maxfield
authors.forename: Ben
authors.initials: B
authors.lastname: Chortkoff
authors.forename: Joslin
authors.initials: J
authors.lastname: Christensen
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D015360:Analgesia, Epidural; D000932:Antiemetics / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000601:surgery*; D019990:Perioperative Care; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000932:Antiemetics; D003907:Dexamethasone