Details

Autor(en) / Beteiligte

• Elias, Kevin M.
• Kang, Stephanie
• Liu, Xiaoxia
• Horowitz, Neil S.
• Berkowitz, Ross S.
• Frendl, Gyorgy

Titel

Anesthetic Selection and Disease-Free Survival Following Optimal Primary Cytoreductive Surgery for Stage III Epithelial Ovarian Cancer

Ist Teil von

• Annals of surgical oncology, 2015-04, Vol.22 (4), p.1341-1348

Ort / Verlag

Boston: Springer US

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Previous studies have offered conflicting results regarding an association between perioperative epidural analgesia and disease-free survival (DFS) following optimal primary cytoreductive surgery for stage III epithelial ovarian cancer. A possible separate role for inhalational anesthetics has not been assessed. Methods We conducted a historical cohort study of all women undergoing optimal primary cytoreduction (<1 cm residual disease) for Stage III epithelial ovarian cancer between January 1, 2007, and December 31, 2011, at Brigham and Women’s Hospital. Cohorts were defined by exposure to perioperative epidural analgesia or exposure to specific volatile anesthetics. The primary outcome was DFS. Results A total of 194 patients met study inclusion criteria. Addition of epidural analgesia was associated with a lower overall rate of ovarian cancer recurrence compared with general anesthesia alone (72 vs. 85 %, p  = 0.028). Longer median DFS was associated with more than 48 h of epidural use (14.9 months) compared with fewer than 24 h (10.9 months) or 24–48 h of epidural use (10.0 months; p  = 0.025). Use of desflurane was associated with a lower overall rate of ovarian cancer recurrence compared with sevoflurane (63 vs. 84 %, p  = 0.01). In multivariate analysis, use of desflurane was independently associated with improved DFS (hazards ratio 0.563; 95% confidence interval 0.33–0.962). Conclusions For patients with Stage III ovarian cancer, use of desflurane is associated with improved DFS following primary cytoreductive surgery compared with other volatile anesthetics. If epidural analgesia offers additional benefit, this effect appears limited to patients with more than 48 h of postoperative epidural use.