Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
Departments of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering, New York, NY, United States of America.
Gynecol Oncol. 2018 Nov;151(2):287-293. doi: 10.1016/j.ygyno.2018.08.024. Epub 2018 Sep 2.
Epidurals are associated with improved outcomes in some solid tumors, presumably due to their effect on surgical stress response. There are limited data on the prognostic significance of epidural anesthesia in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. We sought to assess the impact of epidural anesthesia on the survival outcomes of patients undergoing PDS for advanced ovarian cancer.
In this retrospective study, consecutive patients with stage IIIB-IV epithelial ovarian, fallopian tube, or peritoneal carcinoma who underwent PDS at our institution from 01/2005-12/2013 were identified. Progression-free survival (PFS) and overall survival (OS) with regard to epidural use were analyzed.
Of 648 patients, 435 received an epidural and 213 did not. Patients in the former group were more likely to have higher stage disease (stage IV disease, 26% vs. 16%, respectively; P = .005), carcinomatosis (87% vs. 80%, respectively; P = .027), and bulky upper abdominal disease (66% vs. 58%, respectively; P = .046). Complete gross resection was achieved in 48% and 32%, respectively (P < .001). For the epidural vs. non-epidural groups, median PFS was 20.8 months and 13.9 months, respectively (P = .021); median OS was 62.4 months and 41.9 months, respectively (P < .001). After controlling for confounding factors, including residual disease, epidural use was independently associated with a decreased risk of progression (HR = 1.327; 95% CI, 1.066-1.653) and death (HR = 1.588; 95% CI, 1.224-2.06).
Perioperative epidural use was independently associated with improved PFS and OS in these patients. Epidural anesthesia at the time of PDS may be warranted in this setting.
硬膜外麻醉与某些实体瘤的改善预后相关，这可能是由于其对手术应激反应的影响。在接受初次肿瘤细胞减灭术（PDS）治疗晚期卵巢癌的患者中，硬膜外麻醉的预后意义数据有限。我们旨在评估硬膜外麻醉对接受 PDS 治疗的晚期卵巢癌患者生存结局的影响。
在这项回顾性研究中，我们确定了 2005 年 1 月至 2013 年 12 月期间在我院接受 PDS 的 IIIB-IV 期上皮性卵巢、输卵管或腹膜癌连续患者。分析了硬膜外使用与无硬膜外使用患者的无进展生存期（PFS）和总生存期（OS）。
在 648 名患者中，435 名患者接受了硬膜外麻醉，213 名患者未接受硬膜外麻醉。前者组患者更可能患有更高分期的疾病（IV 期疾病分别为 26%和 16%；P=0.005）、癌性播散（87%和 80%；P=0.027）和上腹部大体积疾病（66%和 58%；P=0.046）。完全肉眼肿瘤减灭术的比例分别为 48%和 32%（P<0.001）。硬膜外组和非硬膜外组的中位 PFS 分别为 20.8 个月和 13.9 个月（P=0.021）；中位 OS 分别为 62.4 个月和 41.9 个月（P<0.001）。在控制了包括残留疾病在内的混杂因素后，硬膜外使用与进展风险降低独立相关（HR=1.327；95%CI，1.066-1.653）和死亡风险降低（HR=1.588；95%CI，1.224-2.06）。
围手术期硬膜外使用与这些患者的 PFS 和 OS 改善独立相关。在这种情况下，PDS 时使用硬膜外麻醉可能是合理的。
