title: Impact of Combination Epidural and General Anesthesia on the Long-Term Survival of Gastric Cancer Patients: A Retrospective Study.
abstract: BACKGROUND Whether regional anesthesia is associated with tumor-free and long-term survival is controversial. Here, we focused on whether epidural anesthesia affects the long-term survival of gastric cancer patients after surgery. MATERIAL AND METHODS We obtained the records of 273 patients undergoing gastric cancer surgery between August 2006 and December 2010. All patients received elective surgery, and the end-point was death. The general anesthesia group comprised 116 patients and the epidural-supplemented group comprised 157 patients. The results were analyzed using a multivariable model to determine the relationship between epidural use and long-term survival. RESULTS No obvious association was detected between epidural use and long-term survival according to the Cox model (P=0.522); the adjusted estimated hazard ratio was 0.919 (95% CI 0.71-1.19). However, according to Kaplan-Meier analysis, epidural anesthesia was associated with long-term survival among younger patients (age up to 64) (p=0.042, log-rank) (but not among older patients (p=0.203, log-rank). A lower American Society of Anesthesiologists (ASA) class and less chemoradiotherapy exposure were also associated with a longer survival. However, advanced tumor stage still has a significant negative impact on survival. CONCLUSIONS No obvious difference was detected between the 2 anesthesia groups, but younger patients may benefit from epidural anesthesia.
authors.affiliation: Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).
authors.forename: Jiangling
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).
authors.forename: Wenjing
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).
authors.forename: Qicheng
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).
authors.forename: Runze
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).
authors.forename: Jun
authors.initials: J
authors.lastname: Fang
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods* / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000379:methods* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D017741:Survivors; D016896:Treatment Outcome