Vogelaar F J, Abegg R, van der Linden J C, Cornelisse H G J M, van Dorsten F R C, Lemmens V E, Bosscha K
Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands,
Int J Colorectal Dis. 2015 Aug;30(8):1103-7. doi: 10.1007/s00384-015-2224-8. Epub 2015 Apr 28.
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.
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.
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).
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.
手术仍然是可治愈性结肠癌治疗的主要手段。否则，手术应激反应可能会增加癌症手术期间及术后癌症播散的可能性。越来越多的证据表明，癌症手术期间的麻醉类型在转移过程中发挥作用。因此，我们评估了麻醉方法是否与结肠癌手术后的长期生存相关。
进行了一项回顾性单中心研究，纳入了1995年至2003年期间在耶罗恩·博世医院接受结直肠癌手术（TNM分期I-IV期）的588例患者。采用Cox比例风险模型进行统计分析。对年龄、性别、合并症、TNM分期、化疗、急诊手术状态和发病年份进行了调整。
在588例中位年龄为70岁的原发性结肠癌患者中，399例（68%）患者接受了硬膜外麻醉下的结肠手术，而189例（32%）患者未接受硬膜外麻醉进行手术。未接受硬膜外镇痛的患者5年生存率为42%，而接受硬膜外镇痛的患者为51%（p = 0.03）。在对相关患者、肿瘤和治疗特征进行调整后，这种效应仍然存在（风险比（HRHRHR）1.30（95%置信区间（CI）1.05 - 1.59），p = 0.01）。对80岁及以上患者（n = 100）的亚组分析显示，接受硬膜外镇痛后总体生存率也更高（风险比1.74（95% CI 1.11 - 2.72），p = 0.01）。
结肠癌手术期间的硬膜外镇痛与更好的总体生存率相关。有必要进行前瞻性试验来评估局部区域镇痛对结肠癌复发的影响。
