Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China.
Int J Colorectal Dis. 2022 Apr;37(4):725-735. doi: 10.1007/s00384-022-04109-7. Epub 2022 Feb 19.
This study aimed to analyze the long-term survival of patients with colorectal cancer after receiving combined epidural-general anesthesia (EGA) or general anesthesia (GA) alone.
The PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase databases were used to search for cohort studies that explored the differences between the effects of EGA and GA on overall survival (OS) and recurrence-free survival (RFS) of patients with colorectal cancer. The hazard ratios (HRs) and their 95% confidence intervals (95%CIs) were used as indicators to evaluate the strength of the effects and were pooled.
Nine studies were included in the meta-analysis. EGA improved the OS of patients with colorectal cancer compared with GA (HR = 0.904, 95%CI 0.871-0.938, P < 0.05). In the subgroup analysis, EGA was more protective for OS of patients with colon cancer than GA (HR = 0.840, 95%CI 0.732-0.963, P < 0.05), but not for OS of patients with rectal cancer (HR = 0.764, 95%CI 0.398-1.469, P > 0.05). Additionally, EGA could not further prolong RFS in patients with colorectal cancer (HR = 1.015, 95%CI 0.942-1.093, P > 0.05), which was the same in the subgroup analysis of patients with colon cancer (HR = 0.908, 95%CI 0.760-1.085, P > 0.05).
EGA could improve the OS of patients with colorectal cancer, especially those with colon cancer, but it could not improve the OS in the subgroup of patients with rectal cancer. This difference may be due to the immune protective function of the parasympathetic nerve innervating the intestinal tubes above the splenic flexure retained by EGA. Additionally, although EGA has a protective effect on RFS in patients with colorectal cancer, the difference was not significant. The design of this analysis is registered and displayed in the PROSPERO database (CRD42021274864).
本研究旨在分析接受硬膜外-全身麻醉（EGA）联合麻醉与单纯全身麻醉（GA）的结直肠癌患者的长期生存情况。
检索 PubMed、MEDLINE、Web of Science、Cochrane 图书馆和 Embase 数据库，查找探讨 EGA 与 GA 对结直肠癌患者总生存（OS）和无复发生存（RFS）影响差异的队列研究。采用风险比（HR）及其 95%置信区间（95%CI）作为效应指标，进行合并分析。
纳入 9 项研究进行荟萃分析。与 GA 相比，EGA 改善了结直肠癌患者的 OS（HR=0.904，95%CI 0.871-0.938，P<0.05）。亚组分析显示，EGA 对结肠癌患者的 OS 保护作用优于 GA（HR=0.840，95%CI 0.732-0.963，P<0.05），但对直肠癌患者的 OS 无明显影响（HR=0.764，95%CI 0.398-1.469，P>0.05）。此外，EGA 并不能进一步延长结直肠癌患者的 RFS（HR=1.015，95%CI 0.942-1.093，P>0.05），亚组分析结果一致，结肠癌患者的 RFS 也无明显差异（HR=0.908，95%CI 0.760-1.085，P>0.05）。
EGA 可改善结直肠癌患者的 OS，尤其是结肠癌患者，但对直肠癌患者的 OS 无明显改善。这种差异可能与 EGA 保留的脾曲以上肠管的副交感神经免疫保护功能有关。此外，尽管 EGA 对结直肠癌患者的 RFS 有保护作用，但差异无统计学意义。本分析的设计已在 PROSPERO 数据库（CRD42021274864）中注册并展示。
