title: Epidural analgesia does not influence anastomotic leakage incidence after open colorectal surgery for cancer: A retrospective study on 1,474 patients.
abstract: BACKGROUND
  Anastomotic leakage is a major cause of morbidity after colorectal surgery. Epidural analgesia is the most effective method for postoperative pain relief after major abdominal surgery. Anyhow, its effect on anastomotic leakage rate is still controversial. This study aimed to compare epidural versus intravenous analgesia as risk factor for anastomotic leakage requiring reoperation in patients undergoing open colorectal surgery for cancer.
  
  
  METHODS
  A retrospective study on 1,474 patients was performed. The Cox proportional hazards model was used to study the relation between primary and secondary factors of risk and anastomotic leakage occurrence within 30 days after elective operation.
  
  
  RESULTS
  Overall 30-day anastomotic leakage requiring reoperation was 4.9% (95%CI: 3.8-6.0%). No difference in anastomotic leakage occurrence was observed between the epidural analgesia group and the intravenous analgesia group (Hazard ratio: 0.94; 95%CI: 0.53-1.67%; P = 0.8338). Females had a rate of anastomotic leakage 43% lower than males (P = 0.0301). The diverting stoma resulted to be protective for anastomotic leakage occurrence (P = 0.0052). AL significantly increased postoperative median length of stay but not in-hospital mortality.
  
  
  CONCLUSIONS
  Epidural analgesia does not influence the AL risk after open colorectal surgery for cancer.
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Piccioni
authors.affiliation: Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Anesthesia and Intensive Care Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Negri
authors.affiliation: School of Anesthesia and Intensive Care, University of Milan, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Casiraghi
authors.affiliation: Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Belli
authors.affiliation: Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Leo
authors.affiliation: Department of Anesthesia, Intensive Care and Palliative Care, Fondazione Istituto Nazionale dei Tumori, Milan, Italy.|Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
authors.forename: Martin
authors.initials: M
authors.lastname: Langer
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000209:etiology; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: analgesia; anastomotic leak; cancer; colorectal; epidural; pain; postoperative