Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial

Autor: Pär Myrelid, Christina Eintrei, Wiebke Falk, Anders Magnuson, Anil Gupta, Peter Matthiessen, Ragnar Henningsson
Rok vydání: 2021
Předmět:
Adult
Male
recurrence
Colorectal cancer
colorectal cancer
Disease-Free Survival
law.invention
open surgery
03 medical and health sciences
0302 clinical medicine
thoracic epidural analgesia
Randomized controlled trial
Anesthesia
Conduction
030202 anesthesiology
law
Neoplasms
Clinical endpoint
medicine
disease-free survival
minimally invasive surgery
patient-controlled intravenous analgesia
Humans
Clinical Investigation
Prospective Studies
Anesthetics
Aged
Pain Measurement
Aged
80 and over
Pain
Postoperative
business.industry
Kirurgi
Hazard ratio
Retrospective cohort study
Analgesia
Patient-Controlled
Middle Aged
medicine.disease
Confidence interval
Analgesia
Epidural
Anesthesiology and Pain Medicine
Opioid
Anesthesia
Morphine
Anesthesia
Intravenous
Surgery
Female
business
Colorectal Neoplasms
medicine.drug
Follow-Up Studies
Zdroj: BJA: British Journal of Anaesthesia
ISSN: 1471-6771
Popis: Background: Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory. Methods: In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT). Results: We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P = 0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups. Conclusions: There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine. Funding Agencies|ALF funding Region Orebro County [OLL-880951]; Regional Research Council, Central Sweden [RFR-298211]; research committee of Region Orebro County [OLL-784751]
Databáze: OpenAIRE
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