Peri-operative Epidural Analgesia Offers No Oncological Benefit Following Open Resection of Colorectal Liver Metastases: Long Term Follow up of Two Randomized Controlled Trials

Abstract

Introduction: The use of epidural analgesia (EA) for liver surgery remains controversial. Reports suggest EA offers a positive impact on survival following liver resection for cancer when compared to systemic opiates. No study has compared the oncological benefit of epidural analgesia compared to local anaesthetic wound infiltration (WI). This study aimed to assess the effect of analgesic modality on survival following liver resection for colorectal liver metastases (CRLM). Method: The survival outcomes of patients who participated in two RCTs were obtained. The included patients had been randomised to receive either EA or WI as perioperative analgesia following open liver resection for CRLM in two UK centres. Baseline data were obtained. Median and five year overall (OS) and disease free survival (DFS) outcomes were compared by Kaplan-Meier survival curves. Results: 96 (EA=49, WI=47) patients were identified from two RCTs as having undergone resection of CRLM. The median follow up time was 61.1 (IQR 30.5-69) months. No differences between the groups' baseline and oncological characteristics were identified. Median OS for EA was 56.6 months and 71.6 months for WI. Median DFS was 18.8 months for EA and 31.2 months for WI. Five year OS was 50.8% for EA and 61.2% for WI (p=0.57). Five year DFS was 38.6% for EA and 46.1% for WI (p=0.39). Conclusions: In contrast to previous reports, EA did not offer a survival advantage following liver resection for CRLM when, on this occasion, compared with WI. Both EA and WI could be considered appropriate for oncological liver surgery.