Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery

Langenbecks Arch Surg. 2015 Jan;400(1):19-26. doi: 10.1007/s00423-014-1248-9. Epub 2014 Sep 21.

Abstract

Purpose: Perioperative regional anesthesia with consecutive reduction of intra- and postoperative systemic opioid requirements in order to improve oncological result after cancer surgery has only been addressed by a few reports. This hypothesis has never been proved in esophageal cancer with a long-term follow-up of more than 5 years. Therefore, we addressed the impact on short- and long-term outcomes of epidural analgesia for esophagus cancer surgery.

Methods: All available records from patients who underwent esophageal cancer surgery from 1995 to 2005 were retrospectively analyzed. Short- and long-term outcome variables including opioid requirements, duration of ICU-stay, survival, and cancer recurrence were compared between patients with and patients without epidural analgesia for abdomino-right-thoracic esophagectomy.

Results: Overall, the analysis included 153 patients, 118 received epidural analgesia; in 35 patients, epidural analgesia was avoided. We found significantly increased postoperative median opioid consumption (10-day intravenous morphine equivalent 187 versus 104 mg) and duration of ICU hospitalization (10.1 vs. 5.9 days, p < 0.05) in the non-epidural group compared with the epidural group. However, there were no significant differences in cancer recurrence (23 % non-epidural group, 27 % epidural group), 1-year mortality (14 vs. 11 %), or 5-year survival (29 vs. 28 %) between the two patient groups.

Conclusions: The results of our study underline the well-known clinical benefits of epidural analgesia for esophagus surgery. However, we found no evidence that the further oncological outcome is determined or significantly influenced by the presence or absence of epidural analgesia.

MeSH terms

  • Adenocarcinoma / mortality*
  • Adenocarcinoma / surgery*
  • Aged
  • Analgesia, Epidural*
  • Analgesics, Opioid / administration & dosage
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / surgery*
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / surgery*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Retrospective Studies

Substances

  • Analgesics, Opioid