Beneficial Effects of Thoracic Epidural Anesthesia on Mortality Rate in Geriatric Patients after Elective Surgery for Colon Cancer: A Study of 215 Consecutive Patients
Author(s): Simon Moormann, Marie Luise Rüebsam, Eva Warnking, Antje Gottschalk, Klaus Hahnenkamp, Hugo Van Aken, Dietrich Doll, Olaf Hagemann, Christian Hönemann
Colorectal cancer is a major cause of death in the industrial world. The mortality and morbidity rates depend on postoperative complications and cancer recurrence. Research suggests that regional anesthesia reduces perioperative stress levels, potentially lowering the risk of complications. Patients with perioperative epidural analgesia might have longer survival times compared with patients without perioperative epidural analgesia.
We compared short and long-term outcome data from 215 patients who underwent open colon cancer surgery by the same surgeon and the same oncologist. Eighty-three patients received general anesthesia plus thoracic epidural analgesia (EPI group), and 132 patients received general anesthesia alone (GA group). Oncological data from a state-wide follow-up database were included. The effects of different perioperative anesthetic techniques on patients’ short and long-term outcomes over 36 months were statistically analyzed (Pearson’s chi-squared test, Student’s t-test, Wilcoxon rank-sum test) as appropriate. A Kaplan-Meier analysis for survival was performed and analyzed by the Wilcoxon rank-sum test.
With the exception of a significantly higher prevalence of arterial hypertension in the EPI group in comparison with the GA group, there were no differences in demographics, tumor staging data, and cancer recurrence rates between the groups. However, mortality rates were significantly different between the groups. Thirty-seven of 132 GA patients (28%) died within 36 months, in comparison with 14 of 83 EPI patients (16.9%, P<0.05). Patients over the age of 70 years in particular significantly benefited from perioperative epidural analgesia and had significantly better survival compared with patients without perioperative epidural analgesia (P<0.05).
Perioperative use of epidural analgesia reduces the 36-month postoperative mortality rate. This effect may be due to the systemic effects of local anesthetics or to a reduced stress response caused by the thoracic epidural analgesia itself.
Patients with colon cancer over the age of 70 years in particular significantly benefited from perioperative epidural analgesia and had longer survival times compared with patients without perioperative epidural analgesia.