Oliveira Thiago, Nakamura Eric Toshiyuki, Harada Fernanda Hanada Baltazar, Olivé Maria Luiza Vianna, Martinez Isabela, Oliveira Arthur, Maegawa Felipe Antonio Boff, Shimanoe Victor H, Tustumi Francisco
Department of Evidence-Based Medicine, Centro Universitario Lusiada, Santos, São Paulo, Brazil.
Department of Surgery, Universidade de Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil; Department of Gastroenterology, Universidade de Sao Paulo, São Paulo, Brazil.
J Gastrointest Surg. 2025 Jul;29(7):102093. doi: 10.1016/j.gassur.2025.102093. Epub 2025 May 21.
Esophageal resection, which is the primary treatment of esophageal cancer, is associated with a high risk of morbidity and often leads to significant postoperative pain. This study aimed to evaluate the effect of thoracic epidural analgesia (TEA) on pain management and postoperative outcomes in esophageal cancer surgery.
A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews identification number: CRD42024501967), encompassing studies from the Embase, PubMed, Cochrane, and LILACS databases. Controlled trials and cohort studies comparing TEA with alternative anesthesia strategies, such as patient-controlled analgesia, were considered for inclusion. The outcomes were pain visual score, use of pain rescue medications, hospital stay, intensive care unit (ICU) stay, blood loss, extubation time, operation time, postoperative complications, severe complications, catheter-related complications, opioid-related sedation, mortality, anastomotic leak, pulmonary complications, reintubation, readmission, and vasoactive drug use.
A total of 15 studies with 16,146 patients were selected, consisting of 7 controlled trials, 7 retrospective cohorts, and 1 prospective cohort. TEA was associated with significant reductions in pain scores (mean difference [MD]: -0.83 [95% CI, -1.18 to -0.49]), length of stay (MD, -2.3 days [95% CI, -2.78 to -1.73]), extubation time (MD, -0.13 h [95% CI, -0.17 to -0.08]), severe postoperative complications (risk difference [RD], -0.05 patients [95% CI, -0.08 to -0.03]), anastomotic leakage (RD, -0.03 [95% CI, -0.04 to -0.01]), and pulmonary complications (RD, -0.10 patients [95% CI, -0.19 to -0.02]). The operation times were slightly longer in the TEA group (MD, 7.77 min [95% CI, 0.69-14.85]). TEA was associated with a higher risk of catheter-related complications (RD, 0.09 [95% CI, 0.01-0.17]) and higher use of vasoactive drugs (RD, 0.02 [95% CI, 0.00-0.04]). No significant differences were observed for ICU stay, blood loss, mortality, reintubation, readmission, opioid sedation, or use of rescue medication.
Our findings highlight TEA as an effective strategy for enhancing postoperative recovery in patients with esophageal cancer. TEA not only reduces pain scores but also improves postoperative surgical outcomes, including fewer complications, shorter extubation times, and reduced hospital stays.
食管癌的主要治疗方法是食管切除术，该手术具有较高的发病风险，且常导致严重的术后疼痛。本研究旨在评估胸段硬膜外镇痛（TEA）对食管癌手术疼痛管理及术后结局的影响。
按照系统评价和Meta分析的首选报告项目指南（国际前瞻性系统评价注册编号：CRD42024501967）进行系统评价和Meta分析，纳入来自Embase、PubMed、Cochrane和LILACS数据库的研究。纳入比较TEA与其他麻醉策略（如患者自控镇痛）的对照试验和队列研究。结局指标包括疼痛视觉评分、疼痛解救药物的使用、住院时间、重症监护病房（ICU）住院时间、失血量、拔管时间、手术时间、术后并发症、严重并发症、导管相关并发症、阿片类药物相关镇静、死亡率、吻合口漏、肺部并发症、再次插管、再次入院以及血管活性药物的使用。
共纳入15项研究，涉及16146例患者，其中包括7项对照试验、7项回顾性队列研究和1项前瞻性队列研究。TEA与疼痛评分显著降低（平均差[MD]：-0.83[95%置信区间，-1.18至-0.49]）、住院时间缩短（MD，-2.3天[95%置信区间，-2.78至-1.73]）、拔管时间缩短（MD，-0.13小时[95%置信区间，-0.17至-0.08]）、严重术后并发症减少（风险差[RD]，-0.05例患者[95%置信区间，-0.08至-0.03]）、吻合口漏减少（RD，-0.03[95%置信区间，-0.04至-0.01]）以及肺部并发症减少（RD，-0.10例患者[95%置信区间，-0.19至-0.02]）相关。TEA组的手术时间略长（MD，7.77分钟[95%置信区间，0.69 - 14.85]）。TEA与导管相关并发症的风险较高（RD，0.09[95%置信区间，0.01 - 0.17]）以及血管活性药物的使用较多（RD，0.02[95%置信区间，0.00 - 0.04]）相关。在ICU住院时间、失血量、死亡率、再次插管、再次入院、阿片类药物镇静或解救药物使用方面未观察到显著差异。
我们的研究结果表明，TEA是提高食管癌患者术后恢复的有效策略。TEA不仅能降低疼痛评分，还能改善术后手术结局，包括减少并发症、缩短拔管时间和缩短住院时间。
