Perioperative epidural use and survival outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer

• Published in: Gynecologic oncology 2018-11, Vol.151 (2), p.287-293
• Main Authors: Tseng, Jill H., Cowan, Renee A., Afonso, Anoushka M., Zhou, Qin, Iasonos, Alexia, Ali, Narisha, Thompson, Errika, Sonoda, Yukio, O'Cearbhaill, Roisin E., Chi, Dennis S., Abu-Rustum, Nadeem R., Long Roche, Kara
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia, Epidural - methods; Carcinoma, Ovarian Epithelial; Cytoreduction Surgical Procedures - methods; Disease-Free Survival; Epidural anesthesia; Fallopian Tube Neoplasms - mortality; Fallopian Tube Neoplasms - pathology; Fallopian Tube Neoplasms - surgery; Female; Humans; Middle Aged; Neoplasms, Glandular and Epithelial - mortality; Neoplasms, Glandular and Epithelial - pathology; Neoplasms, Glandular and Epithelial - surgery; Ovarian cancer; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Perioperative Care - methods; Peritoneal Neoplasms - mortality; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Primary debulking surgery; Residual disease; Retrospective Studies; Survival; Survival Rate; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.08.024

Epidurals are associated with improved outcomes in some solid tumors, presumably due to their effect on surgical stress response. There are limited data on the prognostic significance of epidural anesthesia in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. We sought to assess the impact of epidural anesthesia on the survival outcomes of patients undergoing PDS for advanced ovarian cancer. In this retrospective study, consecutive patients with stage IIIB-IV epithelial ovarian, fallopian tube, or peritoneal carcinoma who underwent PDS at our institution from 01/2005–12/2013 were identified. Progression-free survival (PFS) and overall survival (OS) with regard to epidural use were analyzed. Of 648 patients, 435 received an epidural and 213 did not. Patients in the former group were more likely to have higher stage disease (stage IV disease, 26% vs. 16%, respectively; P = .005), carcinomatosis (87% vs. 80%, respectively; P = .027), and bulky upper abdominal disease (66% vs. 58%, respectively; P = .046). Complete gross resection was achieved in 48% and 32%, respectively (P