Christopherson Rose, James Kenneth E, Tableman Mara, Marshall Prudence, Johnson Frank E
Anesthesiology Service, VA Medical Center and Department of Anesthesiology, OR Health and Science University, Portland, OR 97229, USA.
Anesth Analg. 2008 Jul;107(1):325-32. doi: 10.1213/ane.0b013e3181770f55.
A previously published clinical trial of epidural-supplemented versus general anesthesia, Veterans Affairs Cooperative Study No. 345, showed no difference in 30-day mortality and morbidity rates between the two treatments. We hypothesized that long-term postoperative survival would be increased by epidural anesthesia/analgesia supplementation during colon cancer resection.
We studied long-term survival after resection of colon cancer in a trial of general anesthesia with and without epidural anesthesia and analgesia supplementation for resection of colon cancer in Veterans Affairs Cooperative Study No. 345. Cox and log-normal survival models were used to test the effects of pathological stage, type of anesthesia and other covariates on survival in 177 patients.
The presence of distant metastases had the greatest effect on survival. Thus, analyses were performed separately for patients with and without metastases. For those without metastasis, the hazard ratio for the treatment effects changed at 1.46 years. Before 1.46 years, epidural supplementation was associated with improved survival (P = 0.012), while later, the type of anesthesia did not appear to affect survival (P = 0.27). Hypertension was associated with poorer survival (P = 0.029), as was alcoholism in patients who received epidural anesthesia (P = 0.014). Survival of patients with metastases was unaffected by type of anesthesia. There was a significant age by hypertension interaction (P = 0.002). Patients survived longer if they were hypertensive, but had reduced survival if they were older than 66 years and hypertensive.
Epidural supplementation was associated with enhanced survival among patients without metastases before 1.46 years. Epidural anesthesia had no effect on survival of patients with metastases. Additional studies to confirm or refute these findings are warranted.
先前发表的一项关于硬膜外辅助麻醉与全身麻醉的临床试验（退伍军人事务部合作研究第345号）显示，两种治疗方法在30天死亡率和发病率方面没有差异。我们假设，在结肠癌切除术中，硬膜外麻醉/镇痛辅助可提高术后长期生存率。
在退伍军人事务部合作研究第345号中，我们对结肠癌切除术后的长期生存情况进行了研究，该试验涉及结肠癌切除术中使用全身麻醉以及是否补充硬膜外麻醉和镇痛。使用Cox和对数正态生存模型来测试病理分期、麻醉类型和其他协变量对177例患者生存的影响。
远处转移的存在对生存影响最大。因此，对有转移和无转移的患者分别进行了分析。对于无转移的患者，治疗效果的风险比在1.46年时发生变化。在1.46年之前，硬膜外辅助与生存率提高相关（P = 0.012），而之后，麻醉类型似乎不影响生存（P = 0.27）。高血压与较差的生存相关（P = 0.029），接受硬膜外麻醉的患者中的酗酒情况也与较差的生存相关（P = 0.014）。有转移患者的生存不受麻醉类型影响。年龄与高血压之间存在显著的交互作用（P = 0.002）。高血压患者生存时间较长，但如果年龄超过66岁且患有高血压，则生存时间缩短。
在1.46年之前，硬膜外辅助与无转移患者的生存率提高相关。硬膜外麻醉对有转移患者的生存没有影响。有必要进行更多研究以证实或反驳这些发现。
