Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 225 Changhai Road, Shanghai, China.
Department of Anesthesiology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, China.
Int J Med Sci. 2019 Jan 24;16(2):337-342. doi: 10.7150/ijms.28016. eCollection 2019.
Recently published studies suggest that the anaesthetic technique used during oncologic surgery can improve patient outcomes. Therefore, the authors evaluated the survival of patients with resected colorectal carcinoma liver metastases (CRCLMs) who received either EGA (general anaesthesia [GA] combined with epidural anaesthesia [EA]) or GA alone. We conducted an ambispective cohort study including 225 post-surgical CRCLM patients between May 2007 and July 2012 and performed a follow-up investigation of survival in July 2017. The basic characteristics in the two groups were largely similar. The median (quartiles) recurrence interval for all patients was 10 (2.5, 23) months, and the median (quartiles) survival for CRCLM patients post-surgically was 37 (30.5, 51.5) months. Perioperative EA was associated with survival (P =0.039, log-rank test), with an estimated hazard ratio of 0.737 (95% CI 0.551-0.985) in the univariate analysis. Kaplan-Meier estimates of survival for GA and EGA suggested that GA might provide better outcomes than EGA [P=0.028, hazard ratio of 0.7328 (95% CI 0.5433-0.9884)]. Significant differences in anaesthesia techniques were found (P=0.048), with an adjusted estimated hazard ratio of 0.741 (95% CI 0.550-0.998) in the multivariate analysis. Subgroup analyses of patients in different age groups (< 40, ≥ 40 but <60, and ≥ 60 years old) suggested that no significant differences existed among all three subgroups. Compared with EGA, GA may provide a better survival outcome for CRCLM patients. The benefits of anaesthetic techniques in oncological surgery are most likely related to certain cancer types.
最近发表的研究表明，肿瘤外科手术中使用的麻醉技术可以改善患者的预后。因此，作者评估了接受全身麻醉（GA）联合硬膜外麻醉（EA）或单独 GA 的结直肠癌肝转移（CRCLM）患者的生存情况。我们进行了一项回顾性队列研究，纳入了 2007 年 5 月至 2012 年 7 月期间的 225 例术后 CRCLM 患者，并于 2017 年 7 月对生存情况进行了随访调查。两组患者的基本特征基本相似。所有患者的中位（四分位数）复发间隔为 10（2.5，23）个月，CRCLM 患者术后的中位（四分位数）生存时间为 37（30.5，51.5）个月。围手术期 EA 与生存相关（P=0.039，对数秩检验），单因素分析中，估计的危险比为 0.737（95%CI 0.551-0.985）。GA 和 EGA 的生存 Kaplan-Meier 估计表明，GA 可能比 EGA 提供更好的结果[P=0.028，危险比为 0.7328（95%CI 0.5433-0.9884）]。麻醉技术存在显著差异（P=0.048），多因素分析中调整后的估计危险比为 0.741（95%CI 0.550-0.998）。不同年龄组（<40 岁、≥40 岁但<60 岁和≥60 岁）患者的亚组分析表明，所有三组之间均无显著差异。与 EGA 相比，GA 可能为 CRCLM 患者提供更好的生存结果。麻醉技术在肿瘤外科中的益处可能与某些癌症类型有关。
