Ann Surg：硬膜外麻醉可改善结直肠癌手术患者生存结局

患者Kaplan-Meier生存曲线结果

临床及动物研究表明，通过硬膜外麻醉可取得肿瘤手术后发病率及死亡率方面的潜在益处。但硬膜外止痛麻醉在结直肠癌术后长期结局方面的作用尚有待进一步确定。为此，德国Klinikum Hanau 公司Marco Gruss博士等人进行了一项研究，该研究针对接受手术治疗的结直肠癌患者，旨在确定硬膜外止痛麻醉对患者长期生存的影响。该研究结果发表于2013年4月26日在线出版的《外科学年鉴》(Annals of Surgery)杂志上。

自2003年至2009年期间，共有749例患者在全身麻醉(进行或不进行硬膜外麻醉)情况下，接受了结直肠癌手术治疗。研究人员对相关的临床数据进行了回顾性考察，并利用多变量分析法及Kaplan-Meier作图法进行了分析。

共有442例患者接受了硬膜外麻醉，307例患者未接受硬膜外麻醉。根据观察，硬膜外麻醉患者可取得实质性生存获益(5年生存率: 硬膜外麻醉组, 62%; 非硬膜外麻醉组, 54%; P < 0.02)。接受硬膜外麻醉的患者死亡风险率降低27%。将硬膜外麻醉因素纳入含有年龄、美国麻醉师学会分级结果、肿瘤分期等干扰因素的Cox模型后发现，接受硬膜外麻醉患者可取得显著的生存获益。此外，在美国麻醉师学会分级结果为3至4的患者中，与未接受硬膜外麻醉的患者相比，硬膜外麻醉患者可取得更佳的生存结局。

研究人员最终认为，硬膜外麻醉可改善结直肠癌手术患者的生存结局。临床发病率较高患者通过硬膜外麻醉取得的生存获益更高。

Peridural Analgesia May Affect Long-term Survival in Patients With Colorectal Cancer After Surgery (PACO-RAS-Study): An Analysis of a Cancer Registry.
Abstract
OBJECTIVE:: To determine the effect of peridural analgesia on long-term survival in patients who underwent surgical treatment of colorectal carcinoma. BACKGROUND:: Clinical and animal studies suggest a potential benefit of peridural analgesia on morbidity and mortality after cancer surgery. The effect of peridural analgesia on long-term outcome after surgery for colorectal cancer remains undefined. METHODS:: From 2003 to 2009, there were 749 patients who underwent surgery for colorectal carcinoma under general anesthesia with or without peridural analgesia. Clinical data were reviewed retrospectively and analyzed with multivariate analysis and Kaplan-Meier plots. RESULTS:: There were 442 patients who received peridural analgesia and 307 patients who did not receive peridural analgesia. A substantial survival benefit was observed in patients who received peridural analgesia (5-year survival rate: peridural analgesia, 62%; no peridural analgesia, 54%; P < 0.02). The hazard rate for death was decreased by 27% in patients who received peridural analgesia. When peridural analgesia was included simultaneously in a Cox model with the confounding factors age, American Society of Anesthesiologists classification, and stage, there was a significant survival benefit in patients who received peridural analgesia. In patients with America Society of Anesthesiologists classification 3 to 4, there was significantly greater survival with peridural analgesia than without peridural analgesia (P < 0.009). CONCLUSIONS:: Peridural analgesia may improve survival in patients underwent surgery for colorectal carcinoma. The survival benefit with peridural analgesia was greater in patients who had greater medical morbidity.