title: Anesthetic selection and disease-free survival following optimal primary cytoreductive surgery for stage III epithelial ovarian cancer.
abstract: BACKGROUND
  Previous studies have offered conflicting results regarding an association between perioperative epidural analgesia and disease-free survival (DFS) following optimal primary cytoreductive surgery for stage III epithelial ovarian cancer. A possible separate role for inhalational anesthetics has not been assessed.
  
  
  METHODS
  We conducted a historical cohort study of all women undergoing optimal primary cytoreduction (<1 cm residual disease) for Stage III epithelial ovarian cancer between January 1, 2007, and December 31, 2011, at Brigham and Women's Hospital. Cohorts were defined by exposure to perioperative epidural analgesia or exposure to specific volatile anesthetics. The primary outcome was DFS.
  
  
  RESULTS
  A total of 194 patients met study inclusion criteria. Addition of epidural analgesia was associated with a lower overall rate of ovarian cancer recurrence compared with general anesthesia alone (72 vs. 85 %, p = 0.028). Longer median DFS was associated with more than 48 h of epidural use (14.9 months) compared with fewer than 24 h (10.9 months) or 24-48 h of epidural use (10.0 months; p = 0.025). Use of desflurane was associated with a lower overall rate of ovarian cancer recurrence compared with sevoflurane (63 vs. 84 %, p = 0.01). In multivariate analysis, use of desflurane was independently associated with improved DFS (hazards ratio 0.563; 95% confidence interval 0.33-0.962).
  
  
  CONCLUSIONS
  For patients with Stage III ovarian cancer, use of desflurane is associated with improved DFS following primary cytoreductive surgery compared with other volatile anesthetics. If epidural analgesia offers additional benefit, this effect appears limited to patients with more than 48 h of postoperative epidural use.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA, kelias1@partners.org.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Elias
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kang
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Liu
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage / Q000592:standards*; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000777:Anesthetics