Perioperative epidural use and survival outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer Journal Article

   

Authors:	Tseng, J. H.; Cowan, R. A.; Afonso, A. M.; Zhou, Q.; Iasonos, A.; Ali, N.; Thompson, E.; Sonoda, Y.; O'Cearbhaill, R. E.; Chi, D. S.; Abu-Rustum, N. R.; Long Roche, K.
Article Title:	Perioperative epidural use and survival outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer
Abstract:	Objective: Epidurals are associated with improved outcomes in some solid tumors, presumably due to their effect on surgical stress response. There are limited data on the prognostic significance of epidural anesthesia in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. We sought to assess the impact of epidural anesthesia on the survival outcomes of patients undergoing PDS for advanced ovarian cancer. Methods: In this retrospective study, consecutive patients with stage IIIB-IV epithelial ovarian, fallopian tube, or peritoneal carcinoma who underwent PDS at our institution from 01/2005–12/2013 were identified. Progression-free survival (PFS) and overall survival (OS) with regard to epidural use were analyzed. Results: Of 648 patients, 435 received an epidural and 213 did not. Patients in the former group were more likely to have higher stage disease (stage IV disease, 26% vs. 16%, respectively; P =.005), carcinomatosis (87% vs. 80%, respectively; P =.027), and bulky upper abdominal disease (66% vs. 58%, respectively; P =.046). Complete gross resection was achieved in 48% and 32%, respectively (P <.001). For the epidural vs. non-epidural groups, median PFS was 20.8 months and 13.9 months, respectively (P =.021); median OS was 62.4 months and 41.9 months, respectively (P <.001). After controlling for confounding factors, including residual disease, epidural use was independently associated with a decreased risk of progression (HR = 1.327; 95% CI, 1.066–1.653) and death (HR = 1.588; 95% CI, 1.224–2.06). Conclusions: Perioperative epidural use was independently associated with improved PFS and OS in these patients. Epidural anesthesia at the time of PDS may be warranted in this setting. © 2018 Elsevier Inc.
Keywords:	survival; adult; cancer survival; aged; cancer surgery; primary tumor; major clinical study; overall survival; advanced cancer; cancer risk; cancer patient; ovarian cancer; cytoreductive surgery; progression free survival; peritoneum cancer; cohort analysis; retrospective study; cancer mortality; minimal residual disease; ovary carcinoma; perioperative period; uterine tube carcinoma; epidural anesthesia; carcinomatosis; residual disease; primary debulking surgery; peritoneal carcinoma; human; female; priority journal; article
Journal Title:	Gynecologic Oncology
Volume:	151
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2018-11-01
Start Page:	287
End Page:	293
Language:	English
DOI:	10.1016/j.ygyno.2018.08.024
PUBMED:	30185381
PROVIDER:	scopus
PMCID:	PMC6214778
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85052728364&doi=10.1016%2fj.ygyno.2018.08.024&partnerID=40&md5=e9bd5da7c89311f93fb2fde928e6155c
Notes:	Article -- Export Date: 3 December 2018 -- Source: Scopus

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