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

ABSTRACT: 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.

SUBMITTER: Wu HL

PROVIDER: S-EPMC7807023 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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

Wu Hsiang-Ling HL Tai Ying-Hsuan YH Lin Shih-Pin SP Yang Shung-Haur SH Tsou Mei-Yung MY Chang Kuang-Yi KY

Scientific reports 20210113 1

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 end ...[more]

PMID: 33441716

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Project description:BackgroundPerioperative inflammation is associated with poor oncologic outcomes. Regional analgesia has been shown mitigate some of these inflammatory changes and be associated with better oncologic outcomes in patients with hepatic malignancies. The mechanism for this effect, however, remains unclear. The authors sought to compare systemic biomarker concentrations in a comprehensive and oncologically relevant panel in the perioperative setting between patients undergoing thoracic epidural analgesia (TEA) and intra-venous patient- controlled analgesia (IV-PCA) for resection of hepatic metastatic disease.ResultsClinicopathologic variables and baseline biomarkers were similar between TEA (n = 46) and IV-PCA (n = 16) groups. Of the biomarkers which were significantly changed from baseline, there was a lower fold change from baseline in the TEA patients compared to IV-PCA including IL-6 (13.5vs19.1), MCP-1 (1.9vs3.0), IL-8 (2.4vs3.0), and Pentraxin-3 (10.8vs15.6). Overall decreased systemic concentrations of TGFb signaling were noted in TEA patients on POD1 TGFb3 (243.2 vs. 86.0, p = 0.005), POD3 TGFb1 (6558.0 vs. 2063.3, p = 0.004), POD3 TGFb2 (468.3 vs. 368.9, p = 0.036), POD3 TGFb3 (132.2 vs. 77.8, p = 0.028), and POD5 TGFb3 (306.5 vs. 92.2, p = 0.032). POD1 IL-12p70 concentrations were significantly higher in TEA patients (8.3 vs. 1.6, p = 0.024).ConclusionEpidural analgesia damped the postoperative inflammatory response and systemic immunosuppressive signaling, as well as promoted Th1 systemic signaling early in the post-operative period after hepatic resection for metastatic disease. These differences elaborate on known mechanisms for improved oncologic outcomes with regional anesthesia, and may be considered for biomarker monitoring of effective regional anesthesia in oncologic surgery.Materials and methodsPatient data, including clinicopathologic variables were collected for this study from the database of a randomized controlled trial comparing perioperative outcomes in patients undergoing hepatic resection with TEA vs. IV-PCA. Patients undergoing resection for metastatic disease were selected for this study. Plasma concentrations (pg/mL) of well-studied biomarkers (IL-1b/2/4/5/6/7/8/10/12p70/13/17, MCP-1 IFNγ, TNFα, MIP-1b, GM-CSF, G-CSF, VEGF, Resistin, TGFb1, TGFb2, and TGFb3), as well as novel perioperative markers (CXCL12, CXCL10, Omentin-1, sLeptin R, Vaspin, Pentraxin-3, Galactin-3, FGF-23, PON-1, FGF-21) were measured preoperatively, and on postoperative day (POD)1, POD3, and POD5 using multiplex bead assays. Clinicopathologic variables and perioperative variations in these biomarkers were compared between TEA vs IV-PCA groups.

Project description:PurposePatients with rectal cancer without distant metastases are typically treated with radical surgery. Post curative resection, several factors can affect tumor recurrence. This study aimed to analyze factors related to rectal cancer recurrence after curative resection using different machine learning techniques.MethodsConsecutive patients who underwent curative surgery for rectal cancer between 2004 and 2018 at Gil Medical Center were included. Patients with stage IV disease, colon cancer, anal cancer, other recurrent cancer, emergency surgery, or hereditary malignancies were excluded from the study. The Synthetic Minority Oversampling Technique with Tomek link (SMOTETomek) technique was used to compensate for data imbalance between recurrent and no-recurrent groups. Four machine learning methods, logistic regression (LR), support vector machine (SVM), random forest (RF), and Extreme gradient boosting (XGBoost), were used to identify significant factors. To overfit and improve the model performance, feature importance was calculated using the permutation importance technique.ResultsA total of 3320 patients were included in the study. After exclusion, the total sample size of the study was 961 patients. The median follow-up period was 60.8 months (range:1.2-192.4). The recurrence rate during follow-up was 13.2% (n = 127). After applying the SMOTETomek method, the number of patients in both groups, recurrent and non-recurrent group were equalized to 667 patients. After analyzing for 16 variables, the top eight ranked variables {pathologic Tumor stage (pT), sex, concurrent chemoradiotherapy, pathologic Node stage (pN), age, postoperative chemotherapy, pathologic Tumor-Node-Metastasis stage (pTNM), and perineural invasion} were selected based on the order of permutational importance. The highest area under the curve (AUC) was for the SVM method (0.831). The sensitivity, specificity, and accuracy were found to be 0.692, 0.814, and 0.798, respectively. The lowest AUC was obtained for the XGBoost method (0.804), with a sensitivity, specificity, and accuracy of 0.308, 0.928, and 0.845, respectively. The variable with highest importance was pT as assessed through SVM, RF, and XGBoost (0.06, 0.12, and 0.13, respectively), whereas pTNM had the highest importance when assessed by LR (0.05).ConclusionsIn the current study, SVM showed the best AUC, and the most influential factor across all machine learning methods except LR was found to be pT. The rectal cancer patients who have a high pT stage during postoperative follow-up are need to be more close surveillance.

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

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

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