Long-term Survival after Combined Epidural-General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial.

Abstract

BACKGROUND:

Experimental and observational research suggests that combined epidural-general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural-general anesthesia improves long-term survival in elderly patients.

METHODS:

This article presents a long-term follow-up of patients enrolled in a previous trial conducted at five hospitals. Patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries were randomly assigned to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival.

RESULTS:

Among 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). Among patients assigned to combined epidural-general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P = 0.408. Cancer-specific survival was similar with combined epidural-general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290. Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural-general anesthesia versus 389 of 859 [45%] with general anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P = 0.692. Event-free survival was 466 of 853 [55%] in patients who had combined epidural-general anesthesia versus 450 of 859 [52%] for general anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P = 0.815.

CONCLUSIONS:

In elderly patients having major thoracic and abdominal surgery, combined epidural-general anesthesia with epidural analgesia did not improve overall or cancer-specific long-term mortality. Nor did epidural analgesia improve recurrence-free survival. Either approach can therefore reasonably be selected based on patient and clinician preference.

EDITOR’S PERSPECTIVE:

• Authors: Ya-Ting Du, Ya-Wei Li, Bin-Jiang Zhao, Xiang-Yang Guo, Yi Feng, Ming-Zhang Zuo, Cong Fu, Wei-Jie Zhou, Huai-Jin Li, Ya-Fei Liu, Tong Cheng, Dong-Liang Mu, Yuan Zeng, Peng-Fei Liu, Yan Li, Hai-Yan An, Sai-Nan Zhu, Xue-Ying Li, Hui-Juan Li, Yang-Feng Wu, Dong-Xin Wang, Daniel I Sessler, Peking University Clinical Research Program Study Group
• Journal: Anesthesiology (Anesthesiology) Vol. 135 Issue 2 Pg. 233-245 (08 01 2021) ISSN: 1528-1175 [Electronic] United States
• PMID: 34195784 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.

Topics

• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Analgesia, Epidural (methods, mortality)
• Anesthesia, General (methods, mortality)
• China (epidemiology)
• Drug Therapy, Combination
• Follow-Up Studies
• Geriatric Assessment (methods, statistics & numerical data)
• Incidence
• Surgical Procedures, Operative (mortality)
• Survival