Positive effect on survival of epidural analgesia in patients undergoing cytoreductive surgery for peritoneal metastasis.

Abstract

e15064 Background: Potential benefits of regional analgesia in reduction of cancer recurrence have been reported for colon and ovarian cancer. The aim of this study was to evaluate the influence of regional analgesia with patient controlled epidural analgesia (PCEA) on disease-free survival (DFS) and overall survival (OS) in patients with peritoneal metastasis (PM) of various origins operated to achieve cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: From 2006 to 2015, 734 patients were operate on curative purpose to undergone CRS and HIPEC for PM. Three hundred patients for which details on PCEA were available were included in the present study. Aiming to obtain two well-balanced cohorts for available variables influencing early outcome and survival, the PCEA group was matched 1:1 with the non PCEA group by using a propensity score-based method. Results: Matching criteria included demographic characteristics, ASA score, origin of PM, presence of liver metastasis, Peritoneal Carcinomatosis Index (PCI) and complete resection. The median duration of follow-up was 18 months. In the matched cohort (PCEA: 68, non-PCEA: 68), early outcomes were comparable between the two group in terms of blood lost (200 vs 200 ml), transfusion (15 vs 18%), length of surgery (440 vs 450 min) and of hospitalization (12 vs 13 days) and major morbidity (25 vs 22%). After PS-matching, the PCEA group had better OS comparing non-PCEA (Hazard ratio and 95% confidence interval at 0.41 [0.21 – 0.86]). Improvement of DFS rate in PCEA group was observed only in the original sample but not after PS-matching (HR 95%CI: 0.70 [0.45 – 1.07]). Conclusions: In our study, regional analgesia is associated with improved overall survival and transient effect on disease-free survival in patients with peritoneal metastasis of various origins.