J P N Holler1, J Ahlbrandt, M Gruß, A Hecker, M A Weigand, W Padberg, R Röhrig. 1. Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Justus-Liebig-Universität, Universitätskliniken Gießen und Marburg, Standort Gießen , Gießen, Deutschland.
Abstract
BACKGROUND: The results of recent clinical studies suggest a potential benefit of peridural analgesia (PDA) during general anesthesia on long-term survival in patients after surgery for colorectal cancer. In order to test the hypothesis a meta-analysis was performed. OBJECTIVES: To determine the prognostic impact of perioperative PDA on long-term survival in patients with colorectal cancer who underwent surgical resection. MATERIAL AND METHODS: By searching the relevant literature (up to May 2014) a total of 5 studies were identified from a total of 608 publications and a meta-analysis was carried out. Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) were used to assess the strength of associations. The random effects model was used to analyze the data and a modified forest plot was applied. Additionally, a potential publication bias was visually examined in a funnel plot. RESULTS: A positive association between PDA and improved long-term survival was observed in patients who underwent surgery for colorectal cancer without metastases (HR = 0.81, 95 % CI 0.68-0.96, p = 0.055). CONCLUSION: Despite a publication bias the use of PDA in patients who underwent surgery for colorectal cancer without metastases seemed to be advantageous. Randomized controlled trials are warranted to confirm the positive effects of additional PDA. The exact mechanisms of tumor suppressive effects of PDA have not yet been elucidated.
BACKGROUND: The results of recent clinical studies suggest a potential benefit of peridural analgesia (PDA) during general anesthesia on long-term survival in patients after surgery for colorectal cancer. In order to test the hypothesis a meta-analysis was performed. OBJECTIVES: To determine the prognostic impact of perioperative PDA on long-term survival in patients with colorectal cancer who underwent surgical resection. MATERIAL AND METHODS: By searching the relevant literature (up to May 2014) a total of 5 studies were identified from a total of 608 publications and a meta-analysis was carried out. Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) were used to assess the strength of associations. The random effects model was used to analyze the data and a modified forest plot was applied. Additionally, a potential publication bias was visually examined in a funnel plot. RESULTS: A positive association between PDA and improved long-term survival was observed in patients who underwent surgery for colorectal cancer without metastases (HR = 0.81, 95 % CI 0.68-0.96, p = 0.055). CONCLUSION: Despite a publication bias the use of PDA in patients who underwent surgery for colorectal cancer without metastases seemed to be advantageous. Randomized controlled trials are warranted to confirm the positive effects of additional PDA. The exact mechanisms of tumor suppressive effects of PDA have not yet been elucidated.
Authors: Y Shavit; A Depaulis; F C Martin; G W Terman; R N Pechnick; C J Zane; R P Gale; J C Liebeskind Journal: Proc Natl Acad Sci U S A Date: 1986-09 Impact factor: 11.205
Authors: S S Liu; R L Carpenter; D C Mackey; R C Thirlby; S M Rupp; T S Shine; N G Feinglass; P P Metzger; J T Fulmer; S L Smith Journal: Anesthesiology Date: 1995-10 Impact factor: 7.892
Authors: Rose Christopherson; Kenneth E James; Mara Tableman; Prudence Marshall; Frank E Johnson Journal: Anesth Analg Date: 2008-07 Impact factor: 5.108
Authors: Kalpna Gupta; Smita Kshirsagar; Liming Chang; Robert Schwartz; Ping-Y Law; Doug Yee; Robert P Hebbel Journal: Cancer Res Date: 2002-08-01 Impact factor: 12.701
Authors: Jadie Plücker; Naita M Wirsik; Alina S Ritter; Thomas Schmidt; Markus A Weigand Journal: Langenbecks Arch Surg Date: 2021-02-01 Impact factor: 3.445