Association of Perioperative Use of Epidural Analgesia with Disease Free Survival in Epithelial Ovarian Cancer- A Retrospective Cohort Observational Study with Propensity Score Matched Analysis

Abstract

Background: Recurrence is common after surgery for epithelial ovarian cancer and is multifactorial. Perioperative factors affecting stress and inflammation have an influence on immunity and thus cancer recurrence. The effect of peri-operative epidural anesthesia has been quoted to be beneficial by decreasing stress. A retrospective analysis of perioperative Epidural analgesia use (EA) was compared to general anesthesia (GA) without epidural, with disease free survival (DFS)as the outcome.
 Methods: We did a retrospective observational study of patients with epithelial ovarian malignancy who had undergone surgery between 2013 and 2017. Cohorts were primarily divided based on receipt of epidural analgesia. Perioperative patient, anesthetic, and tumor related data were collected. The aim was to estimate the association of epidural analgesia with disease free survival (DFS). To prevent bias due to skewed covariate distribution propensity score match was done matching all covariates.
 Results: We had 312 patients with age ranging from 18 to 77. The median DFS in months was 32.73±25.6 for the entire cohort while it was 54.81±28.69 for the GA group and 27.23±21.84 for EA group. After PSM median DFS was 35.33 for the full cohort and it was 46 and 34 months for the GA and EA groups, respectively. Multivariate Cox regression analysis demonstrated that only patients who were undergoing primary surgery had survival advantage (P<0.013). Perioperative epidural analgesia was not associated with survival benefit (P=0.480).
 Conclusion: Perioperative use of epidural analgesia did not offer survival benefit in epithelial ovarian cancer as measured by disease free survival.