Since epidural anesthesia is known to reduce immunosuppression, should it be preferred in patients with cancer who are undergoing surgery? Additionally, do systemic opioids contribute to cancer recurrence, metastasis, and biochemical progression, further encouraging the use of epidural anesthesia for patients with cancer?
In the article featured in this month’s issue of Anesthesia & Analgesia, “The Relationship Between Neuraxial Anesthesia and Advanced Ovarian Cancer-Related Outcomes in the Chilean Population,” Dr. Hector J. Lacassie, Departamento de Anestesiología, Hospital Clínico U.C., Santiago, Chile, and colleagues identified patients with ovarian cancer from a clinical registry to determine whether the use of epidural anesthesia and analgesia affected time to recurrence and overall survival. The patients had stage IIIC or IV ovarian cancer, and were undergoing surgical removal. Some patients received an epidural anesthetic in combination with inhaled anesthesia and afterwards received patient-controlled epidural analgesia using a combination of local anesthetics and opioids. Other patients received either PCA with morphine or continuous infusions of tramadol with morphine as a rescue analgesic.
The authors studied 80 patients. Of these, 39 received epidural anesthesia. Propensity matching included the operative surgeon and optimal cytoreduction. When using propensity scoring, there was no difference between groups in time to recurrence (the median time was 1.6 years for the epidural group and 1.4 years for the PCA group) or survival (the median time was 3.3 years for the epidural group and 2.7 years for the PCA group).
Patients in this study were not randomized and the study size was small. Also, patients had one specific type of cancer and the cancer was advanced. Whether different results might be seen in patients with less advanced cancer or with other types of cancer is not clear.