Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?

Wu, Hsiang Ling; Tai, Ying Hsuan; Chang, Wen-Kuei; Chang, Kuang Yi; Tsou, Mei-Yung; Cherng, Yih-Giun; Lin, Shih Pin

doi:10.1097/md.0000000000015442

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…In previous studies equivalent morphine consumption has contradictory impact upon disease free survival. While it decreased survival on early stages of lung cancer [38] had no impact on colorectal or esophageal cancers [30,39,40].…”

Section: Discussionmentioning

confidence: 99%

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

Díaz‐Cambronero

Mazzinari

Giner

et al. 2020

Cancers

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Preclinical evidence has shown increased expression of mu opioid receptor 1 (MOR-1) in colorectal cancer although its association with disease-free and overall survival (DFS and OS) has not been investigated. We hypothesized that MOR-1 was overexpressed in tumor samples compared to normal tissue and this was associated with decreased DFS and OS. We carried out a retrospective study assessing the association of MOR-1 tumor expression with long-term outcomes by immunohistochemistry in normal and tumor samples from 174 colorectal cancer patients. The primary endpoint was five years of DFS. Secondary endpoints were five years of OS, the difference in MOR-1 expression between normal and tumor tissue and the occurrence of postoperative complications. Multivariable Cox regression showed no significant association between MOR-1 expression and DFS (HR 0.791, 95% CI 0.603–1.039, p = 0.092). MOR-1 expression was higher in tumor tissue compared to non-tumor tissue. No associations were found between MOR-1 expression and OS or postoperative complications. These findings suggest that although MOR-1 is over-expressed in colorectal cancer samples there is no association to increased risk of recurrence or mortality. Future studies are warranted to elucidate the role of cancer stage, genetic polymorphism, and quantitative assessment of MOR-1 over-expression on long-term outcomes in colorectal cancer.

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Section: Discussionmentioning

confidence: 99%

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

Díaz‐Cambronero

Mazzinari

Giner

et al. 2020

Cancers

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“…First, unrecorded variables cannot be further controlled in the analytical models, including perioperative uses of opioids, tumour-involved margin, genetic profiles of tumour, detailed information of chemotherapy and radiotherapy, and postoperative complication events 34 , 35 . Of note, our prior study demonstrated no definite correlation between postoperative morphine dose and oncological outcome in patients with colorectal cancer 36 . Second, we did not include data about contraindications to epidurals, such as coagulation profiles and physical frailty.…”

Section: Discussionmentioning

confidence: 68%

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

Tai

Lin

et al. 2021

Sci Rep

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The relationship between epidural analgesia and rectal cancer outcome is not fully clarified. We aimed to investigate the putative effect 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 first cancer recurrence. Secondary endpoints were all-cause mortality and cancer-specific 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 non-significant (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 cancer-specific survival (HR 1.113, 95% CI 0.826–1.501, p = 0.482) was non-significant either. For sensitivity tests, quintile stratification and stepwise forward model selection analyses showed similar results. We did not find a significant association between epidural analgesia and risk of recurrence, all-cause mortality, or cancer-specific mortality in patients with rectal cancer undergoing tumour resection.

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“…Notably, our previous study showed no definite association between morphine consumption within 72 hours after surgery and long-term cancer outcome in patients with colorectal cancer using intravenous patient-controlled analgesia. 35 Second, the procedure of propensity score matching resulted in a loss of patient sample and statistical power. Third, the follow-up time for patients treated with EA was significantly longer than for patients without EA, which may possibly lead to outcome assessment bias.…”

Section: Discussionmentioning

confidence: 99%

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

Tai

Mandell

et al. 2020

BMJ Open

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ObjectivesWhether epidural analgesia affects cancer outcomes remains controversial. Most previous investigations ignored the confounding potential of important pathological factors on cancer outcomes. This study aimed to assess the association between epidural analgesia and cancer recurrence or death after resections for colon cancer.DesignRetrospective cohort study.SettingA single-medical centre in Taiwan.ParticipantsPatients with stage I through III colon cancer undergoing bowel resection and receiving either epidural analgesia or intravenous opioid analgesia from 2005 to 2014.Primary and secondary outcome measuresPrimary outcome was postoperative recurrence-free survival and secondary outcome was overall survival.ResultsA total of 2748 and 1218 patients were analysed before and after propensity score matching. Cox regression analyses did not demonstrate any association between epidural analgesia and recurrence or death after matching (HR 0.89, 95% CI 0.65 to 1.21 for recurrence; 0.72, 95% CI 0.48 to 1.09 for death). Independent prognostic factors for cancer recurrence and death were higher level of preoperative carcinoembryonic antigen, perioperative blood transfusion, advanced cancer stage and pathological lymphovascular invasion.ConclusionsNo definite association was found between epidural analgesia and risk of recurrence or death in patients undergoing colon cancer resection.

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Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?

Cited by 11 publications

References 25 publications

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

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

Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan

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