Pei Jun-Peng, Zhang Chun-Dong, Liang Yu, Zhang Cheng, Wu Kun-Zhe, Zhao Zhe-Ming, Dai Dong-Qiu
Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.
Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ann Transl Med. 2020 Apr;8(7):473. doi: 10.21037/atm.2020.03.127.
This study was conducted retrospectively to investigate the survival of patients undergoing gastric cancer surgery with epidural combined with general anesthesia (EGA) and general anesthesia alone (GA).
We retrospectively analyzed 596 patients with gastric cancer who were scheduled for radical resection. Propensity score matching was performed at a 1:1 ratio between GA (n=97) and EGA (n=97) to reduce selection bias. Univariate and multivariate analyses were used to identify factors significantly correlated with recurrence and/or metastasis and prognosis. The 5-year overall survival rates of patients receiving EGA and GA alone were compared.
After the propensity scores were matched, there were 97 patients who underwent EGA and 97 patients who underwent GA. For the entire population, reconstruction type, pN stage, and complications were significantly correlated with prognosis based on multivariate analyses. For patients with a recurrence and/or metastasis, lymphadenectomy and pN stage were shown to be independent prognostic factors by multivariate analysis.
In summary, patients might benefit from EGA as a result of better analgesic and anti-inflammatory effects, fewer postoperative complications, higher safety, and a lower rate of metastasis and recurrence is conducive to postoperative recovery in patients with gastric cancer.
本研究旨在回顾性调查接受硬膜外联合全身麻醉（EGA）和单纯全身麻醉（GA）的胃癌手术患者的生存率。
我们回顾性分析了596例计划进行根治性切除的胃癌患者。在GA组（n = 97）和EGA组（n = 97）之间以1:1的比例进行倾向评分匹配，以减少选择偏倚。采用单因素和多因素分析来确定与复发和/或转移及预后显著相关的因素。比较了接受EGA和单纯GA的患者的5年总生存率。
倾向评分匹配后，有97例患者接受了EGA，97例患者接受了GA。对于总体人群，基于多因素分析，重建类型、pN分期和并发症与预后显著相关。对于有复发和/或转移的患者，多因素分析显示淋巴结清扫和pN分期是独立的预后因素。
总之，由于具有更好的镇痛和抗炎作用、更少的术后并发症、更高的安全性以及更低的转移和复发率，EGA可能使胃癌患者受益，有利于患者术后恢复。
