Epidural Anesthesia During Primary Debulking Surgery for Advanced Ovarian Cancer
Posted: Thursday, November 1, 2018
Patients with advanced ovarian cancer undergoing primary debulking surgery who were treated with perioperative epidural anesthesia had a significantly higher median progression-free and overall survival than those who did not, according to a retrospective study by Jill H. Tseng, MD,of the Memorial Sloan Kettering Cancer Center, and colleagues, published in Gynecologic Oncology. With a limited number of modifiable prognostic factors for ovarian cancer, the researchers advised that epidural anesthesia may be an intervention worth implementing.
The investigators focused on 648 patients with stage IIIB to IV epithelial ovarian, fallopian tube, or peritoneal carcinoma: 435 received perioperative epidural anesthesia, and 213 did not. Before the surgery, patients in the epidural group had a significantly higher stage of disease, higher rates of carcinomatosis, and longer median operative times. Additionally, the timing of the intraoperative epidural initiation lacked standardization, starting intraoperatively in 385 patients and postoperatively in the remaining 49.
The median progression-free survival for the epidural arm was 20.8 months, compared with 13.9 months for the nonepidural arm. The epidural group had a significantly higher median overall survival than the nonepidural group, both before and after controlling for surgeon clustering effect. When the investigators controlled for other factors, they found that not receiving epidural anesthesia was independently associated with a 33% increased risk of disease progression when compared with epidural anesthesia. Other prognostic factors with significant associations included older age, stage IV compared with stage III disease, optimal and suboptimal debulking compared with complete gross resection, and the presence of carcinomatosis or bulky upper abdominal disease.
Dr. Tseng and colleagues proposed that further prospective studies may uncover the specific oncologic benefits related to epidural anesthesia and the relationship between immune function and tumor metastasis in ovarian cancer.