文献导读：麻醉与肿瘤||硬膜外镇痛会减少肿瘤复发吗？

本文由“小麻哥的日常”授权转载

很多研究认为麻醉可能影响免疫系统、可能与肿瘤复发相关，现分享一篇发表在Anesthesiology杂志上的最新文献，供参考！

摘要译文（供参考） 硬膜外镇痛与结直肠癌术后复发：一项基于丹麦回顾性登记的队列研究 

背景： 手术是结直肠癌的主要治疗手段。然而，手术诱发的免疫和体液反应可能促进肿瘤微转移。有人认为硬膜外镇痛可以保护免疫能力，防止肿瘤转移。因此，作者验证了硬膜外镇痛可以减少结直肠癌手术后癌症复发的假设。

方法： 利用丹麦结直肠癌组数据库和丹麦麻醉数据库，选择2004年至2018年间因结直肠癌手术而术后无残留肿瘤组织的患者。暴露组的定义是术前置入硬膜外导管进行镇痛。主要结果是结直肠癌复发，次要结果是死亡率。根据丹麦卫生注册中心的数据，使用经验证的算法确定复发。随访至死亡或2018年9月7日。作者使用倾向评分匹配来调整潜在的术前混杂因素。 

结果： 在11618人的研究人群中，3496人（30.1%）在手术前置入硬膜外导管。硬膜外镇痛组在全凭静脉麻醉、剖腹手术和直肠肿瘤中的比例较高，2009年至2012年间硬膜外镇痛的使用频率最高。倾向评分匹配的研究队列由每组2980人组成，具有平衡的基线协变量。中位随访时间为58个月（四分位数范围为29至86）。硬膜外镇痛组有567人（19.0%）复发，无硬膜外镇痛组有610人（20.5%）复发。作者发现硬膜外镇痛与复发（危险比，0.91；95%可信区间，0.82至1.02）或死亡率（危险比，1.01；95%可信区间，0.92至1.10）之间没有关联。 

结论： 在结直肠癌手术中，硬膜外镇痛与癌症复发率无统计学显著相关性。

原文摘要 Epidural Analgesia and Recurrence after Colorectal Cancer Surgery: A Danish Retrospective Registry-based Cohort Study Background: Surgery is the main curative treatment for colorectal cancer. Yet the immunologic and humoral response to surgery may facilitate progression of micro-metastases. It has been suggested that epidural analgesia preserves immune competency and prevents metastasis formation. Hence, the authors tested the hypothesis that epidural analgesia would result in less cancer recurrence after colorectal cancer surgery. Methods: The Danish Colorectal Cancer Group Database and the Danish Anesthesia Database were used to identify patients operated for colorectal cancer between 2004 and 2018 with no residual tumor tissue left after surgery. The exposure group was defined by preoperative insertion of an epidural catheter for analgesia. The primary outcome was colorectal cancer recurrence, and the secondary outcome was mortality. Recurrences were identified using a validated algorithm based on data from Danish health registries. Follow-up was until death or September 7, 2018. The authors used propensity score matching to adjust for potential preoperative confounders. Results: In the study population of 11,618 individuals, 3,496 (30.1%) had an epidural catheter inserted before surgery. The epidural analgesia group had higher proportions of total IV anesthesia, laparotomies, and rectal tumors, and epidural analgesia was most frequently used between 2009 and 2012. The propensity score-matched study cohort consisted of 2,980 individuals in each group with balanced baseline covariates. Median follow-up was 58 months (interquartile range, 29 to 86). Recurrence occurred in 567 (19.0%) individuals in the epidural analgesia group and 610 (20.5%) in the group without epidural analgesia. The authors found no association between epidural analgesia and recurrence (hazard ratio, 0.91; 95% CI, 0.82 to 1.02) or mortality (hazard ratio, 1.01; 95% CI, 0.92 to 1.10). Conclusions: In colorectal cancer surgery, epidural analgesia was not statistically significantly associated with less cancer recurrence.

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校对：Mijohn.米江

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