Long-term Survival after Combined Epidural–General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial

Background Experimental and observational research suggests that combined epidural–general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic opioid consumption blunting surgery-related inflammation. This study therefore tested the primary hypothesis improves in elderly patients. Methods article presents a follow-up of patients enrolled previous trial conducted at five hospitals. Patients aged 60 to 90 yr scheduled for major noncardiac thoracic abdominal surgeries were randomly assigned either with postoperative epidural analgesia or general alone intravenous analgesia. The outcome was overall survival. Secondary outcomes included cancer-specific, recurrence-free, event-free Results Among 1,802 who randomized underlying trial, 1,712 analysis; 92% had cancer. median duration 66 months (interquartile range, 61 80). anesthesia, 355 853 (42%) died compared 326 859 (38%) deaths alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 1.24; P = 0.408. Cancer-specific similar (327 [38%]) (292 [34%]): 1.09; 0.93 1.28; 0.290. Recurrence-free 401 [47%] versus 389 [45%] 0.97; 0.84 1.12; 0.692. Event-free 466 [55%] 450 [52%] 0.99; 0.86 0.815. Conclusions In having surgery, did not cancer-specific mortality. Nor recurrence-free Either approach can reasonably be selected based on patient clinician preference. Editor’s Perspective What We Already Know about Topic Article Tells Us That Is New