Table 2.
Selected retrospective studies of regional anaesthesia and clinical outcomes. BCR, biochemical recurrence; CSS, cancer-specific survival; GA, general anaesthesia; HR, hazard ratio; OR, odds ratio; OS, overall survival; PCA, patient-controlled analgesia; PFS, progression-free survival; PVB, paravertebral block; RCT-PHA, RCT-post hoc analysis; RFS, recurrence-free survival; TURBT, trans-urethral resection of bladder tumour; PCEA, patient-controlled epidural analgesia.
| Study authors | Year | Type | Surgery type | Techniques compared | Significant results |
|---|---|---|---|---|---|
| Biki and colleagues76 | 2008 | RC | Radical prostatectomy | GA+epidural (n=102); GA+opioid (n=123) | 57% reduction in BCR in epidural group |
| Tsui and colleagues78 | 2010 | RCT-PHA | Radical prostatectomy | GA+epidural (n=49); GA (n=50) | No difference in disease-free survival |
| Wuethrich and colleagues79 | 2010 | RC | Radical prostatectomy | GA+epidural (n=105); GA+opioid/NSAID (n=158) | Improved PFS in epidural group (HR: 0.45); no difference in BCR, CSS, or OS |
| Forget and colleagues80 | 2011 | RC | Radical prostatectomy | GA+epidural (n=578); GA (n=533) | No difference in BCR-free survival |
| Wuethrich and colleagues81 | 2013 | RC | Radical prostatectomy | GA+epidural (n=67); GA+opioid/NSAID (n=81) | No difference in BCR, RFS, or OS |
| Roiss and colleagues82 | 2014 | RC | Radical prostatectomy | GA+spinal (n=3047); GA alone (n=1725) | No difference in BCR, RFS, or OS |
| Sprung and colleagues83 | 2014 | RC | Radical prostatectomy | GA+epidural (n=486); GA+opioids (n=486) | No difference in RFS, CSS, or OS |
| Scavonetto and colleagues84 | 2014 | RC | Radical prostatectomy | GA+neuraxial (n=1642); GA alone (n=1642) | GA alone associated with increased systemic progression (HR: 2.81; P=0.008) and mortality (HR: 1.32; P=0.047) |
| Tseng and colleagues85 | 2014 | RC | Radical prostatectomy | Spinal+sedation (n=1166); GA (n=798) | No difference in BCR |
| Lee and colleagues86 | 2017 | RC | Thoracotomy for lung cancer | GA+epidural (n=619); GA+PVB (n=536); GA+PCA (n=574) | PVB associated with increased OS; no difference with epidural or PCA; no difference in recurrence between the three groups |
| Christopherson and colleagues87 | 2008 | RCT-PHA | Colectomy | GA+epidural (n=85); GA (n=92) | Improved OS with epidural in those without metastases at time of surgery, but only up to 1.46 yr postoperative |
| Gottschalk and colleagues88 | 2010 | RC | Colectomy | GA+epidural (n=256); GA (n=253) | No difference in RFS overall; improved RFS in patients aged >64 yr |
| Gupta and colleagues89 | 2011 | RC | Colectomy | GA+epidural (n=562); GA+PCA (n=93) | Epidural use for rectal (HR: 0.45) cancers associated with improved OS; no difference seen for colon cancers |
| Cummings and colleagues90 | 2012 | RC | Colectomy | GA+epidural (n=9670); GA (n=32 481) | Improved OS in epidural group (HR: 0.91), but no difference in cancer recurrence |
| Day and colleagues91 | 2012 | RC | Laparoscopic colectomy | GA+epidural (n=107); GA+spinal (n=144); GA+PCA (n=173) | No difference in OS or 5 yr disease-free survival |
| Holler and colleagues92 | 2013 | RC | Colectomy | GA+epidural (n=442); GA (n=307) | Improved OS in epidural group (HR: 0.73) |
| Vogelaar and colleagues93 | 2015 | RC | Colectomy | GA+epidural (n=399); GA (n=189) | Improved OS in GA group (HR: 0.77) |
| Hiller and colleagues94 | 2014 | RC | Gastrectomy or oesophagectomy | GA+epidural (n=97); GA (n=43) | Epidurals associated with improved OS and RFS at 2 yr in oesophagectomy group; no difference in gastrectomy group |
| Cummings and colleagues95 | 2014 | RC | Gastrectomy | GA+epidural (n=766); GA (n=1979) | No difference in OS or recurrence rate |
| Heinrich and colleagues96 | 2015 | RC | Oesophagectomy | GA+epidural (n=118); GA (n=35) | No difference in RFS or OS |
| Li and colleagues97 | 2016 | RC | Oesophagectomy | GA+epidural (n=178); GA (n=178) | No difference in OS or recurrence risk |
| Shin and colleagues98 | 2017 | RC | Gastrectomy | Epidural PCA (n=4325); i.v. PCA (n=374) | No difference in OS or RFS |
| Wang and colleagues99 | 2017 | RC | Gastrectomy | GA+epidural (n=1390); GA (n=2856) | Improved OS in epidural group (HR: 0.65) |
| Lacassie and colleagues100 | 2013 | RC | Advanced ovarian cancer | GA+epidural (n=37); GA (n=43) | No difference in OS or time to recurrence |
| Lin and colleagues101 | 2011 | RC | Ovarian serous adenocarcinoma | GA+epidural (n=106); GA+opioids (n=37) | Decreased OS in GA+opioids group (HR: 1.214) |
| de Oliveira and colleagues102 | 2011 | RC | Ovarian cancer debulking | GA+epidural (n=55); GA (n=127) | Intraoperative epidural use associated with reduced recurrence risk (HR: 0.37) |
| Capmas and colleagues103 | 2012 | RC | Ovarian cancer complete cytoreduction | GA+PCEA (n=47); GA (n=47) | No difference in OS or RFS |
| Tseng and colleagues104 | 2018 | RC | Ovarian cancer debulking | GA+epidural (n=435); GA (n=213) | Improved PFS and OS in epidural group |
| Doiron and colleagues105 | 2016 | RC | Radical cystectomy | GA+epidural (n=887); GA (n=741) | No difference in OS or CSS |
| Weingarten and colleagues106 | 2016 | RC | Radical cystectomy | GA+spinal (n=195); GA (n=195) | No difference in OS or RFS |
| Chipollini and colleagues107 | 2018 | RC | Radical cystectomy | GA+epidural (n=215); GA (n=215) | Worse RFS (HR: 1.67) and CSS (HR: 1.53) in epidural group |
| Choi and colleagues108 | 2017 | RC | TURBT | Spinal (n=718); GA (n=158) | Lower recurrence rate in spinal group (HR: 0.636) |
| Koumpan and colleagues109 | 2018 | RC | TURBT | Spinal (n=135); GA (n=96) | Increased recurrence rate (OR: 2.06) and earlier time to recurrence (HR: 1.57) in GA group |
| Zimmitti and colleagues110 | 2016 | RC | Colorectal liver metastectomy | GA+epidural (n=390); GA (n=120) | Epidural associated with improved RFS (HR: 0.74), but not OS |
| Exadaktylos and colleagues77 | 2006 | RC | Breast | GA+PVB (n=50); GA+opioid (n=79) | Increased recurrence-free survival in PVB group at 3 yr (88% vs 77%; P=0.012) |
| Myles and colleagues111 | 2011 | RCT-PHA | Abdominal cancer surgery | GA+epidural (n=230); GA (n=216) | No difference in OS or RFS |