Abstract
Whether epidural anesthesia and analgesia (EA) is beneficial for postoperative cancer outcomes remains controversial and we conducted this historical cohort study to evaluate the association between EA and long-term outcomes following surgery for renal cell carcinoma (RCC). We collected patients receiving RCC surgery from 2011 to 2017 and followed up them until February 2020. Patient attributes, surgical factors and pathological features were gathered through electronic medical chart review. The association between EA and recurrence-free and overall survival after surgery was evaluated using Cox regression models with inverse probability of treatment weighting (IPTW) to balance the observed covariates. The median follow-up time for the 725 included patients was 50 months (interquartile range: 25.3–66.5) and 145 of them (20%) received perioperative EA. We demonstrated EA use was associated with better recurrence-free survival [IPTW adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.49–0.83, p < 0.001] and overall survival [IPTW adjusted HR: 0.66, 95% CI: 0.49–0.89, p = 0.006] in patients receiving surgical resection for RCC. More prospective studies are needed to verify this connection between EA and superior cancer outcomes after RCC surgery.
Highlights
Life expectancy is increasing along with the progression and improvement of medical care, cancer remains one of the leading causes of death around the world and cancer treatment is still a great challenge in contemporary medicine [1]
Surgery can directly activate the hypothalamic-pituitary-adrenal axis and sympathetic nerve system to increase the levels of catecholamine, prostaglandins and acute inflammatory cytokines that further suppress the cytotoxic activity of macrophages and natural killer (NK) cells [5]
Perioperative epidural anesthesia and analgesia (EA) effectively attenuate neuroendocrine stress responses related to surgery, they reduce intraoperative volatile anesthetics and opioid consumption by blocking noxious afferent inputs transmitted to the central nervous system, and further preserve host immunity [4, 7, 8]
Summary
Life expectancy is increasing along with the progression and improvement of medical care, cancer remains one of the leading causes of death around the world and cancer treatment is still a great challenge in contemporary medicine [1]. Surgical intervention is the mainstay treatment for the control and cure of most solid tumors but postoperative local or distant metastasis, which causes 90% of deaths, remains a common reason for morbidity and mortality in cancer patients [2, 3]. EA Effects on Cancer Outcomes themselves suppress the host’s immunity which is inhibiting pre-existing micro-metastases, and manipulation during surgery can disseminate cancer cells which are shed from the primary tumor to the blood stream or lymphatic system intraoperatively [4]. Few studies have investigated the association between EA and postoperative outcomes after surgery for renal cell carcinoma (RCC) [8]
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