Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Objectives: Whether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer.

Design: Retrospective cohort study.

Setting: A single-medical centre in Taiwan.

Participants: Patients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014.

Primary and secondary outcome measures: Primary outcome was postoperative recurrence-free survival and secondary outcome was overall survival.

Results: A total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion.

Conclusions: No definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.

Keywords: anaesthesia in oncology; colorectal surgery; gastrointestinal tumours; pain management.