Mu D L, Xue C, An B, Wang D X
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.
Department of Anesthesiology, Aerospace Center Hospital, Beijing 100049, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Dec 18;53(6):1152-1158. doi: 10.19723/j.issn.1671-167X.2021.06.024.
To investigate the effect of epidural anesthesia on the long-term prognosis of patients after selective colorectal cancer resection surgery.
This was a retrospective cohort study and approved by local institution review board. Patients who underwent selective colorectal cancer resection surgery from August 2011 to December 2012 in Peking University First Hospital were enrolled. The patients were divided into general anesthesia (GA) group and combined epidural-general anesthesia (EGA) group according to anesthesia type. Primary outcome was patient's long-term survival status. Secondary outcome included the overall incidence of in-hospital complications and length of postoperative in-hospital stay. Propensity score was used to match cases between the two groups based on the probability of receiving EGA. Survival was analyzed by Kaplan-Meier analysis and compared by Log-rank test between the two groups. Multivariate Cox regression analysis was used to investigate the relationship between epidural anesthesia and other variables with long-term survival status.
A total of 264 patients were entered into final analysis, including 166 cases in GA group and 98 cases in EGA group. Mean age of the patients was (63.3±12.1) years and mean survival time was 47.2 (95% 45.7-48.7) months. Before the propensity score match, the mortality in EGA group was 16.9% (28/166) and 9.2% (9/98) in GA group. But comparison between the two groups had no statistical significance (=0.091). After the propensity score match, 87 paired cases were matched and analyzed. The risk of long-term mortality in EGA group was lower than that of GA group by Kaplan-Meier analysis (5.7% .16.1%, =0.344, 95% 0.124-0.955, =0.041). Mean survival time of EGA group was longer than that of GA group (50.3 months . 42.9 months, =0.032). Multivariate Cox regression ana-lysis showed that EGA, in comparison with GA, was related with lower risk of long-term mortality (=0.326, 95% 0.117-0.909, =0.032). Age (=1.042, 95% 1.001-1.085, =0.046) and preoperative lymph node metastasis (=2.924, 95% 1.162-7.356, =0.023) were also related with increased risk of long-term mortality.
Present study found that perioperative use of epidural anesthesia and analgesia was associated with improvement of the patient's long-term survival. Well-designed studies are needed to verify this hypothesis.
探讨硬膜外麻醉对选择性结直肠癌切除术后患者长期预后的影响。
这是一项回顾性队列研究，经当地机构审查委员会批准。纳入2011年8月至2012年12月在北京大学第一医院接受选择性结直肠癌切除手术的患者。根据麻醉方式将患者分为全身麻醉（GA）组和硬膜外-全身联合麻醉（EGA）组。主要结局是患者的长期生存状况。次要结局包括院内并发症的总发生率和术后住院时间。采用倾向评分根据接受EGA的概率对两组病例进行匹配。通过Kaplan-Meier分析进行生存分析，并通过Log-rank检验在两组之间进行比较。采用多变量Cox回归分析探讨硬膜外麻醉及其他变量与长期生存状况之间的关系。
共有264例患者纳入最终分析，其中GA组166例，EGA组98例。患者的平均年龄为（63.3±12.1）岁，平均生存时间为47.2（95% 45.7 - 48.7）个月。在倾向评分匹配前，EGA组的死亡率为16.9%（28/166），GA组为9.2%（9/98）。但两组之间的比较无统计学意义（P = 0.091）。倾向评分匹配后，对87对匹配病例进行分析。通过Kaplan-Meier分析，EGA组的长期死亡风险低于GA组（5.7%对16.1%，P = 0.344，95%置信区间0.124 - 0.955，P = 0.041）。EGA组的平均生存时间长于GA组（50.3个月对42.9个月，P = 0.032）。多变量Cox回归分析显示，与GA相比，EGA与较低的长期死亡风险相关（P = 0.326，95%置信区间0.117 - 0.909，P = 0.032）。年龄（P = 1.042，95%置信区间1.001 - 1.085，P = 0.046）和术前淋巴结转移（P = 2.924，95%置信区间1.162 - 7.356，P = 0.023）也与长期死亡风险增加相关。
本研究发现围手术期使用硬膜外麻醉和镇痛与患者长期生存的改善相关。需要设计良好的研究来验证这一假设。
