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Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery

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Abstract

Purpose

Perioperative regional anesthesia with consecutive reduction of intra- and postoperative systemic opioid requirements in order to improve oncological result after cancer surgery has only been addressed by a few reports. This hypothesis has never been proved in esophageal cancer with a long-term follow-up of more than 5 years. Therefore, we addressed the impact on short- and long-term outcomes of epidural analgesia for esophagus cancer surgery.

Methods

All available records from patients who underwent esophageal cancer surgery from 1995 to 2005 were retrospectively analyzed. Short- and long-term outcome variables including opioid requirements, duration of ICU-stay, survival, and cancer recurrence were compared between patients with and patients without epidural analgesia for abdomino-right-thoracic esophagectomy.

Results

Overall, the analysis included 153 patients, 118 received epidural analgesia; in 35 patients, epidural analgesia was avoided. We found significantly increased postoperative median opioid consumption (10-day intravenous morphine equivalent 187 versus 104 mg) and duration of ICU hospitalization (10.1 vs. 5.9 days, p < 0.05) in the non-epidural group compared with the epidural group. However, there were no significant differences in cancer recurrence (23 % non-epidural group, 27 % epidural group), 1-year mortality (14 vs. 11 %), or 5-year survival (29 vs. 28 %) between the two patient groups.

Conclusions

The results of our study underline the well-known clinical benefits of epidural analgesia for esophagus surgery. However, we found no evidence that the further oncological outcome is determined or significantly influenced by the presence or absence of epidural analgesia.

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Authors’ contributions

Joachim Schmidt and Sebastian Heinrich designed the study. Data acquisition was performed by Susanne Merkel and Katrin Janitz. Sebastian Heinrich, Joachim Schmidt, and Peter Klein analyzed and interpreted the data. Writing and drafting of manuscript was in responsibility of the corresponding author Sebastian Heinrich. Joachim Schmidt and Peter Klein critically revised the manuscript.

Conflicts of interest

None of the authors has conflicts of interest or any relationship to products, companies, or procedures named in the study.

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Authors and Affiliations

  1. Department of Anesthesiology, Friedrich-Alexander-Universität, Krankenhausstraße 12, Erlangen-Nürnberg, 91054, Bavaria, Germany

    Sebastian Heinrich, Katrin Janitz & Joachim Schmidt

  2. Department of Surgery, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany

    Susanne Merkel & Peter Klein

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  1. Sebastian Heinrich
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  2. Katrin Janitz
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  4. Peter Klein
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Correspondence to Sebastian Heinrich.

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Heinrich, S., Janitz, K., Merkel, S. et al. Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery. Langenbecks Arch Surg 400, 19–26 (2015). https://doi.org/10.1007/s00423-014-1248-9

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  • DOI: https://doi.org/10.1007/s00423-014-1248-9

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