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Epidural analgesia associated with better survival in colon cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Surgery remains the mainstay of treatment for potentially curable colon cancer. Otherwise, the surgical stress response might increase the likelihood of cancer dissemination during and after cancer surgery. There is growing evidence that the type of anaesthesia during cancer surgery plays a role in the metastatic process. Therefore, we assessed if the method of anaesthesia is associated with long-term survival after colon cancer surgery.

Method

A retrospective single-centre study was conducted including 588 patients who underwent colorectal cancer surgery, TNM stage I–IV, in the Jeroen Bosch Hospital between 1995 and 2003. The Cox proportional hazard model was used for statistical analysis. Adjustments were made for age, sex, comorbidity, TNM stage, chemotherapy, emergency surgery status and year of incidence.

Results

Of the 588 primary colon cancer patients with a median age of 70 years, 399 (68 %) patients underwent colon surgery with epidural anaesthesia, whilst 189 (32 %) patients were operated without epidural anaesthesia. Five-year survival for patients not receiving epidural analgesia was 42 % versus 51 % for patients receiving epidural analgesia (p = 0.03). This effect remained after adjustment for relevant patient, tumour, and treatment characteristics (hazard ratio (HR) 1.30 (95 % confidence interval (CI) 1.05–1.59), p = 0.01). Subgroup analysis in patients of 80 years and older (n = 100) showed also a better overall survival after receiving epidural analgesia (HR 1.74 (95 % CI 1.11–2.72), p = 0.01).

Conclusion

Epidural analgesia during colon cancer surgery was associated with a better overall survival. Prospective trials evaluating the effects of locoregional analgesia on colon cancer recurrence are warranted.

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Acknowledgments

The author wishes to thank Esther van den Broek, MSc, and Jorien M. Willems MD, PhD for their support with the statistical analysis and for critically reading the manuscript.

Conflict of interest

None declared.

Disclosures

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ’s Hertogenbosch, The Netherlands

    F. J. Vogelaar, R. Abegg & K. Bosscha

  2. Department of Pathology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ’s Hertogenbosch, The Netherlands

    J. C. van der Linden

  3. Department of Anesthesiology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, ’s Hertogenbosch, The Netherlands

    H. G. J. M. Cornelisse & F. R. C. van Dorsten

  4. Department of Surgery, VieCuri Medical Centre, PO Box 1926, 2900 BX, Venlo, The Netherlands

    F. J. Vogelaar

  5. Department of Research, Eindhoven Cancer Registry/Comprehensive Cancer Centre South, PO Box 231, 5600 AE, Eindhoven, The Netherlands

    V. E. Lemmens

  6. Department of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    V. E. Lemmens

Authors
  1. F. J. Vogelaar
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  2. R. Abegg
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  3. J. C. van der Linden
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  4. H. G. J. M. Cornelisse
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  5. F. R. C. van Dorsten
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  6. V. E. Lemmens
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  7. K. Bosscha
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Corresponding author

Correspondence to F. J. Vogelaar.

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Vogelaar, F.J., Abegg, R., van der Linden, J.C. et al. Epidural analgesia associated with better survival in colon cancer. Int J Colorectal Dis 30, 1103–1107 (2015). https://doi.org/10.1007/s00384-015-2224-8

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  • DOI: https://doi.org/10.1007/s00384-015-2224-8

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