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Epidural analgesia and survival after esophageal cancer surgery: a retrospective cohort study
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DOI：10.1186/s12885-026-16721-9.png)
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Abstract
En 中文
The recommended treatment for esophageal cancer is surgery, but the immune response to surgical intervention can promote the progression of cancer. Epidural analgesia (EA) is thought to preserve immune function. We investigated whether survival after surgery for esophageal cancer was improved by the use of epidural analgesia. We identified patients in Sun Yat-sen University Cancer Center who underwent surgery due to esophageal cancer from 2013 to 2022 and did not have residual tumor tissue after surgery. The primary outcome was the postoperative overall survival (OS), with recurrence-free survival (RFS) and postoperative metastasis-free survival (MFS) as secondary outcomes. To account for potential preoperative confounders, we used propensity score matching (PSM), as well as inverse probability of treatment weighting (IPTW). Among 1090 individuals in the database, 149 (13.7%) received EA. After PSM, each group had 141 individuals and the baseline characteristics were balanced. Follow-up was a median 26.1 months (interquartile range [IQR] 15.1-63.5). Mortality was recorded in 36.2% of the EA group and 35.5% of the intravenous analgesia (IA) group. EA was not significantly associated with mortality (P = 0.230, hazard ratio [HR] 1.27, 95% confidence interval [CI] 0.86 to 1.88) or metastasis (P = 0.538, HR 0.82, 95% CI 0.43 to 1.55). However, EA was significantly associated with lower levels of recurrence (P = 0.002, HR 0.18, 95% CI 0.05 to 0.61). EA in esophageal cancer surgery was not significantly associated with reduced mortality or metastasis, however it may be associated with lower recurrence rates. Further prospective studies are required to verify this association between EA and cancer outcomes following esophageal cancer surgery.
Keywords:
Epidural analgesia
Intravenous analgesia
Esophageal cancer
Survival
Recurrence
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