Impact of epidural anesthesia on the outcome of elderly patients with endometrial cancer : results of a propensity score-matched analysis

Abstract

Introduction: Epidural anesthesia is a standard procedure to mitigate pain during surgery for endometrial cancer (EC). Little data exist about the influence of epidural anesthesia on the oncological outcome in elderly patients with EC. This retrospective study aimed to investigate potential correlations between epidural anesthesia and cancer recurrence in patients with EC. Methods: We screened the medical records of patients ≥60 years treated surgically for EC at the University Medical Center Mainz between January 2008 and December 2019. All women underwent general anesthesia (GA) alone or combined with epidural anesthesia (EGA). Cox regression, the Kaplan-Meier method and propensity score matching were used to analyze the prognostic influence of the anesthesiologic regime on survival. Results: A total of 152 women with EC were included. Twenty-nine patients (19.1%) formed the EGA cohort. The median time of follow-up (FU) was 31 months (interquartile range [IQR]: 8–67.5). The EGA cohort showed more in-hospital complications (27.6 vs. 8.9%; p = 0.006), especially thromboembolic events (3 vs. 0 events; p = 0.006), as well as a longer hospital stay (11 [IQR: 8–13] vs. 7 [IQR: 4–9] days; p < 0.001). Twenty-six patients (17.1%) developed a recurrence in the follow-up at a median of 13 months [IQR: 7.75–29.5]. Thirty-two patients died during FU (21.1%). The EGA cohort showed higher FIGO stages and a higher histological grading than the GA cohort. In the Kaplan-Meier analysis, EGA showed a significantly reduced 5-year recurrence-free survival (RFS) (36.5% vs. 72.6%, p < 0.001) and overall survival (OS) (58.6% vs. 79.9%, p = 0.008). However, in multivariate Cox regression analysis including FIGO stages and histological grading, EGA did not influence RFS (HR: 2.02; 95%-CI: [0.99–4.12], p = 0.054), and OS (HR: 1.03; 95%-CI: [0.40–2.66], p = 0.951). This was backed up by the propensity score- matched analysis for survival (RFS: p = 0.604, OS: p = 0.86). Conclusion: Considering risk factors, epidural anesthesia in combination with GA did not differ in recurrence-free and overall survival compared to GA. Prospective randomized trials are warranted in order to further evaluate this topic.