Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Anesthesiology. 2010 Jul;113(1):27-34. doi: 10.1097/ALN.0b013e3181de6d0d.
Animal studies suggest that regional anesthesia and optimal postoperative analgesia independently reduce cancer metastasis. Retrospective clinical studies suggest reductions in recurrence of several cancer types in patients receiving perioperative neuraxial analgesia. Thus, the authors determined the association between perioperative epidural analgesia and cancer recurrence in patients undergoing colorectal cancer surgery.
After obtaining approval of institutional review board, the authors reviewed the records of 669 patients undergoing colorectal cancer surgery between January 2000 and March 2007. Follow-up ended in November 2008. The authors' primary outcome was time to cancer recurrence. Cox proportional hazards models were used.
Two hundred fifty-six patients who received epidural analgesia and 253 who did not were analyzed in a multivariable model to assess the association between epidural use and cancer recurrence. Overall, no association between epidural use and recurrence was found (P = 0.43), with an adjusted estimated hazard ratio of 0.82 (95% CI 0.49-1.35). In post hoc analyses, epidural use was associated with a lower cancer recurrence in older patients (age older than 64 yr), but not in younger (interaction P = 0.01). A sensitivity analysis using propensity score analysis found similar results.
In contrast to previous retrospective studies in the colon, breast, and prostate cancer surgery, the authors found that the use of epidural analgesia for perioperative pain control during colorectal cancer surgery was not associated with a decreased cancer recurrence; however, a potential benefit was observed in older patients. The benefit of regional anesthesia on cancer recurrence may thus depend on the specific tumor type.
动物研究表明，区域麻醉和最佳术后镇痛可独立降低癌症转移。回顾性临床研究表明，接受围手术期脊神经轴索镇痛的患者几种癌症类型的复发率降低。因此，作者确定了围手术期硬膜外镇痛与接受结直肠癌手术患者癌症复发之间的关联。
在获得机构审查委员会的批准后，作者回顾了 2000 年 1 月至 2007 年 3 月期间接受结直肠癌手术的 669 名患者的记录。随访于 2008 年 11 月结束。作者的主要结果是癌症复发的时间。使用 Cox 比例风险模型。
在多变量模型中，对接受硬膜外镇痛的 256 例患者和未接受硬膜外镇痛的 253 例患者进行了分析，以评估硬膜外使用与癌症复发之间的关系。总体而言，未发现硬膜外使用与复发之间存在关联（P = 0.43），调整后的估计风险比为 0.82（95%CI 0.49-1.35）。在事后分析中，硬膜外使用与年龄较大的患者（年龄大于 64 岁）的癌症复发率较低相关，但与年龄较小的患者无关（交互 P = 0.01）。使用倾向评分分析的敏感性分析得出了类似的结果。
与以前在结肠癌、乳腺癌和前列腺癌手术中的回顾性研究相反，作者发现，在结直肠癌手术中使用硬膜外镇痛控制围手术期疼痛与降低癌症复发率无关；然而，在老年患者中观察到了潜在的益处。因此，区域麻醉对癌症复发的益处可能取决于特定的肿瘤类型。
