Comparison of Combined General-Epidural Anesthesia with General Anesthesia Effects on Survival and Cancer Recurrence: A Meta-Analysis of Retrospective and Prospective Studies

Abstract

ObjectiveAnimals underwent combined general-epidural anesthesia (EGA) is reported to have better long-time outcome than general anesthesia (GA). This study aimed to make overall evaluation of the association between these two anesthetic techniques and prognosis of cancer patients undergoing surgery.MethodsRelated databases such as PubMed and EMbase were searched for eligible studies that evaluated the influence of EGA and GA on the prognosis of cancer patients undergoing surgery. Selected studies were evaluated according to the inclusion criteria by two reviewers respectively, followed by data extraction and quality assessment. The odds ratio (OR) with their 95% confidence intervals (CIs) were calculated to assess the influence strength of EGA and GA on prognosis of cancer patients.ResultsA total of ten studies involving 3254 patients were included. The overall results demonstrated that there was no significant difference between EGA and GA group (OR = 0.88, 95% CI 0.73 to 1.06, P = 0.187) concerning postoperative recurrence and metastasis rate. In regard to the following two factors: cancer category and time of follow-up, subgroup analysis identified significant differences between EGA and GA in the group of patients with prostate cancer and the group with follow-up less than or equal to two years (OR = 0.66, 95% CI 0.46 to 0.95, P = 0.027; OR = 0.70, 95% CI 0.51 to 0.98, P = 0.035; respectively) concerning postoperative recurrence and metastasis rate. However, no significant difference was found in the group of patients with colorectal cancer (OR = 1.06, 95% CI 0.84–1.33, P = 0.62).ConclusionsThis meta-analysis showed that EGA might be associated with improvement in prognosis of patients with operable prostate cancer and the cancer patients with follow-up less than or equal to two years. However, no obvious relationship between the improvement in prognosis of colorectal cancer and EGA were detected, comparing to GA. Furthermore, all the results should be interpreted cautiously, as heterogeneous data were used for analyzing.

Effects of Different Anaesthesia Methods on Perioperative Cellular Immune Function and Long-term Outcomes in Patients Undergoing Radical Resection of Esophageal Cancer: A Prospective Cohort Study

“…The anaesthetic regimen of epidural anaesthesia combined with general anaesthesia has been reported to exhibit the advantages of maintaining normal hormone levels and requiring less general anaesthetics and/or opioids [9,22], which complies with the case in this study. A recent study [23] revealed that thoracotomy with a thoracic epidural block exerts a decreased impact on postoperative lymphocyte responses compared with surgery performed under general anaesthesia.…”

“…It has been hypothesized that the anaesthetic management impacts the long-term outcome following surgery, and that an anaesthetic treatment exhibiting low potential for immunosuppression reduces relapse [33]. Pei et al [22] reported that EA may improve the outcome for patients with prostate cancer; they hypothesized that EA is concerned with immunoreaction and oncocytology. The statistical analysis in this study con rmed this hypothesis.…”

Influence of opioids on immune function in patients with cancer pain: from bench to bedside

“…Meta‐analyses for the effect of neuraxial blockade on cancer surgery have generated mixed findings from the heterogeneous and mostly retrospective studies that were included. One concluded that there was no advantage for overall or progression‐free survival (Cakmakkaya et al, ), whereas another suggested there might be a benefit for neuraxial blockade for prostate cancer surgery, but not for colonic cancer (Pei et al, ). The most recent and largest meta‐analysis (incorporating findings from 21 studies) reported an association between improved recurrence‐free and overall survival with neuraxial anaesthesia (compared to general anaesthetic alone), especially in patients having colorectal cancer surgery (Weng et al, ).…”

The perioperative immune response

“…However, the clinical benefit of this combined approach remains unclear. A meta-analysis of studies comparing a technique of combined epidural and general anaesthesia versus general anaesthesia alone failed to convincingly demonstrate a benefit in terms of cancer recurrence [33]. However, in a review of nearly 400,000 patients undergoing hip or knee arthroplasty, whilst the benefit of neuraxial anaesthesia alone was replicated in terms of lesser infection risk any protective effect appeared markedly reduced in the cohort that received a combined general and regional anaesthesia technique [34].…”