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Peridural Analgesia May Affect Long-term Survival in Patients With Colorectal Cancer After Surgery (PACO-RAS-Study): An Analysis of a Cancer Registry

Holler, Julia P. N. MD*; Ahlbrandt, Janko; Burkhardt, Ernst MD; Gruss, Marco MD§; Röhrig, Rainer MD; Knapheide, Julia*; Hecker, Andreas MD*; Padberg, Winfried MD*; Weigand, Markus A. MD

doi: 10.1097/SLA.0b013e3182915f61
Original Articles

Objective: To determine the effect of peridural analgesia on long-term survival in patients who underwent surgical treatment of colorectal carcinoma.

Background: Clinical and animal studies suggest a potential benefit of peridural analgesia on morbidity and mortality after cancer surgery. The effect of peridural analgesia on long-term outcome after surgery for colorectal cancer remains undefined.

Methods: From 2003 to 2009, there were 749 patients who underwent surgery for colorectal carcinoma under general anesthesia with or without peridural analgesia. Clinical data were reviewed retrospectively and analyzed with multivariate analysis and Kaplan-Meier plots.

Results: There were 442 patients who received peridural analgesia and 307 patients who did not receive peridural analgesia. A substantial survival benefit was observed in patients who received peridural analgesia (5-year survival rate: peridural analgesia, 62%; no peridural analgesia, 54%; P < 0.02). The hazard rate for death was decreased by 27% in patients who received peridural analgesia. When peridural analgesia was included simultaneously in a Cox model with the confounding factors age, American Society of Anesthesiologists classification, and stage, there was a significant survival benefit in patients who received peridural analgesia. In patients with America Society of Anesthesiologists classification 3 to 4, there was significantly greater survival with peridural analgesia than without peridural analgesia (P < 0.009).

Conclusions: Peridural analgesia may improve survival in patients underwent surgery for colorectal carcinoma. The survival benefit with peridural analgesia was greater in patients who had greater medical morbidity.

In 749 patients who underwent surgery for colorectal carcinoma under general anesthesia with or without peridural analgesia, a substantial survival benefit was observed in those with peridural analgesia. In patients with American Society of Anesthesiologists classification 3 to 4, there was significantly greater survival with peridural analgesia than without peridural analgesia.

*Department of General, Visceral, Thoracic and Transplant Surgery

Department of Anesthesiology, Intensive Care and Pain Medicine

Tumor Center, Justus-Liebig-University of Giessen and Marburg, Campus Giessen, Germany

§Department of Anesthesiology, Intensive Care and Pain Medicine, Klinikum Hanau GmbH, Hanau, Germany.

Reprints: Marco Gruss, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, Klinikum Hanau GmbH, Hanau, Germany, Leimenstr. 2063450 Hanau am Main. E-mail: Marco.Gruss@chiru.med.uni-giessen.de.

Disclosure: Supported by funding from the Justus-Liebig-University Giessen and the University hospital Giessen and Marburg GmbH. There was no other financial support. The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.