Beneficial Effects of thoracic epidural anaesthesia on mortality after elective surgery for colon cancer: a survey of 215 consecutive patients

Abstract Background: Colorectal cancer is a major cause of death in the industrial world. The mortality and morbidity rates depend on the incidence of postoperative complications and cancer recurrence. Data from basic science support the view that regional anaesthesia reduces perioperative stress levels, potentially resulting in a lower risk of complications and cancer relapse. Methods:   We compared short and long-term outcome data in 215 patients who underwent open colon cancer surgery by the same surgeon and the same oncologist. 83 patients received general anesthesia plus thoracic epidural analgesia (EPI group) and 132 patients received general anaesthesia alone (GA group). Oncological data from a state-wide follow-up database were included. The effects of different perioperative anaesthetic techniques on patients’ short and long-term outcome (36 month) were statistically analysed (Pearson’s chi-squared test, Student’s t-test, Wilcoxon rank sum test) as appropriate. A Kaplan Meyer Analysis for survival was performed and analysed by Wilcoxon rank sum test. Results: With the exception of a significantly higher prevalence of arterial hypertension in the EPI group in comparison with the GA group, there were no differences in demographic, tumour staging data and cancer recurrence rates between the groups. However, mortality rates were significantly different between the groups. 37 of 132 GA patients (28%) died within 36 months, in comparison with 14 of 83 EPI patients (16.9%, P < 0.05). Patients over the age of 70 in particular significantly benefited from perioperative epidural analgesia and had a significantly better survival compared with patients without perioperative epidural analgesia (p<0.05). Discussion:  Perioperative use of epidural analgesia reduces the 36-month postoperative mortality rate. This effect may be due to systemic effects of local anaesthetics or to a reduced stress response caused by the thoracic epidural analgesia itself.