A Comparison of the Effects of Epidural Analgesia Versus Traditional Pain Management on Outcomes After Gastric Cancer Resection: A Population-Based Study
Cummings, Kenneth C. III MD, MS*; Patel, Meatal MPH†; Htoo, Phyo Than MD, MPH†; Bakaki, Paul M. MD, PhD†; Cummings, Linda C. MD, MS‡; Koroukian, Siran PhD§
Background and Objectives:
Epidural analgesia may
increase survival after cancer surgery by reducing recurrence. This
population-based study compared survival and treated recurrence after
gastric cancer resection between patients receiving epidurals and those
who did not.
Methods:
We used the linked federal Surveillance,
Epidemiology, and End Results Program/Medicare database to identify
patients aged 66 years or older with nonmetastatic gastric carcinoma
diagnosed 1996 to 2005 who underwent resection. Exclusions included
diagnosis at autopsy, no Medicare Part B, familial cancer syndrome,
emergency surgery, and laparoscopic procedures. Epidurals were
identified by Current Procedural Terminology codes. Treated
recurrence was defined as chemotherapy greater than or equal to 16
months and/or radiation greater than or equal to 12 months after
surgery. Recurrence was compared by conditional logistic regression.
Survival was compared via marginal Cox proportional hazards regression
model.
Results:
We identified 2745 patients, 766 of whom had
epidural codes. Patients receiving epidurals were more likely to have
regional disease, be white, and live in areas with relatively high
socioeconomic status. Overall treated recurrence was 25.6% (27.5%
epidural and 24.9% nonepidural). In the adjusted logistic regression,
there was no difference in recurrence (odds ratio, 1.40; 95% confidence
interval [CI], 0.96–2.05). Median survival did not differ: 28.1 months
(95% CI, 24.8–32.3) in the epidural versus 27.4 months (95% CI,
24.8–30.0) in the nonepidural groups. The marginal Cox models showed no
association between epidural use and mortality (adjusted hazard ratio,
0.93; 95% CI, 0.84–1.03).
Conclusions:
There was no difference between groups
regarding treated recurrence or survival. Whether this is true or simply
a result of insufficient power is unclear. Prospective studies are
needed to provide stronger evidence.
Copyright © 2014 by American Society of Regional Anesthesia and Pain Medicine.
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