【原】【罂粟摘要】硬膜外镇痛对直肠癌切除术后复发或死亡率的影响

罂粟花anesthGH 2021-07-21

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硬膜外镇痛对直肠癌切除术后复发或死亡率的影响

贵州医科大学高鸿教授课题组

翻译：任文鑫编辑：佟睿审校：曹莹

总结

硬膜外镇痛与直肠癌预后的关系尚未完全阐明。我们的目的是研究硬膜外镇痛对直肠肿瘤切除术后复发和死亡率的影响。在这项单中心队列研究中，我们连续招募了2005-2014年间接受肿瘤切除术的I-III期直肠癌患者。患者接受硬膜外镇痛或静脉阿片类药物镇痛以控制术后疼痛。主要观察指标是首次癌症复发。次要观察指标是全因死亡率和癌症特异性死亡率。我们收集了1282例进行逆概率治疗加权分析的患者，其中237例患者(18.5%)使用硬膜外麻醉。随访时间中位数为46.1个月。加权COX回归分析显示硬膜外镇痛与无复发生存率的关系无显著性意义(调整风险比[HR]0.941，95%CI 0.791~1.119，p=0.491)。同样，硬膜外镇痛与总生存率(HR 0.997，95%CI 0.775-1.283，p=0.984)或肿瘤特异性生存率(HR 1.113，95%CI 0.826-1.501，p=0.482)之间的关系也不显著。对于敏感性测试，五分位分层和逐步正向模型选择分析显示了类似的结果。在接受肿瘤切除术的直肠癌患者中，我们没有发现硬膜外镇痛与复发风险、全因死亡率或肿瘤特异性死亡率之间的显著关联。

Epidural analgesia does not impact recurrence or mortality in patients after rectal cancer resection

Summary

The relationship between epidural analgesia and rectal cancer outcome is not fully clarifed. We aimed to investigate the putative efect of epidural analgesia on the risks of recurrence and mortality after rectal tumour resection. In this monocentric cohort study, we consecutively enrolled patients with stage I–III rectal cancer who underwent tumour resection from 2005 to 2014. Patients received epidural analgesia or intravenous opioid-based analgesia for postoperative pain control. Primary endpoint was frst cancer recurrence. Secondary endpoints were all-cause mortality and cancer-specifc

mortality. We collected 1282 patients in the inverse probability of treatment weighting analyses, and 237 (18.5%) used epidurals. Follow-up interval was median 46.1 months. Weighted Cox regression analysis showed the association between epidural analgesia and recurrence-free survival was nonsignifcant (adjusted hazard ratio [HR] 0.941, 95% CI 0.791–1.119, p = 0.491). Similarly, the association between epidural analgesia and overall survival (HR 0.997, 95% CI 0.775–1.283, p = 0.984) or cancerspecifc survival (HR 1.113, 95% CI 0.826–1.501, p = 0.482) was non-signifcant either. For sensitivity tests, quintile stratifcation and stepwise forward model selection analyses showed similar results. We did not fnd a signifcant association between epidural analgesia and risk of recurrence, all-cause mortality, or cancer-specifc mortality in patients with rectal cancer undergoing tumour resection.