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

OBJECTIVE: To investigate the influence of epidural anaesthesia and analgesia (EA) on cancer recurrence and overall survival after surgery for gastric cancer. STUDY DESIGN AND SETTING: A retrospective study which involved patients with stage I–III gastric cancer undergoing curative resection in a medical centre from January 2012 to December 2017 and followed up until December 2019 through electronic medical chart review. Patient demographics, anaesthetic and surgical characteristics and pathologic features were also gathered. PRIMARY AND SECONDARY OUTCOME MEASURES: The effects of EA on postoperative cancer recurrence and overall survival were evaluated using proportional hazards regression models with inverse probability of treatment weighting (IPTW). Multivariable Cox regression analyses were conducted for sensitivity analysis as well. RESULTS: Among the 413 patients with median follow-up of 38.5 months (IQR: 22.1–59.7), 66 (16.0%) received EA after gastric cancer surgery. EA was not associated with greater cancer recurrence (IPTW-adjusted HR: 0.55, 95% CI: 0.27 to 1.13, p=0.102) or cancer specific (IPTW- adjusted HR: 0.53, 95% CI: 0.27 to 1.04, p=0.07) and all-cause mortality (IPTW-adjusted HR: 0.65, 95% CI: 0.37 to 1.16, p=0.143) after gastric cancer resections. For sensitivity analysis, multivariable Cox regression analysis also generated non-significant EA effects on cancer recurrence and survival after surgery. CONCLUSIONS: There was no significant association between EA and cancer recurrence or overall survival in patients with stage I–III gastric cancer receiving surgical resection of primary tumour. Prospective study should be considered to elucidate the relationship between EA and cancer outcomes after gastric cancer surgery.