Thoracic Epidural Analgesia Is Not Associated With Improved Survival After Pancreatic Surgery: Long-Term Follow-Up of the Randomized Controlled PAKMAN Trial-Reference-Cited by-同舟云学术

Thoracic Epidural Analgesia Is Not Associated With Improved Survival After Pancreatic Surgery: Long-Term Follow-Up of the Randomized Controlled PAKMAN Trial

Published:2024-02-09 Issue: Volume: Page:
ISSN:0003-2999
Container-title:Anesthesia & Analgesia
language:en
Short-container-title:

Author:

Klotz Rosa¹²,Ahmed Azaz³⁴,Tremmel Anja⁵,Büsch Christopher⁶,Tenckhoff Solveig²,Doerr-Harim Colette⁷,Lock Johan F.⁸,Brede Elmar-Marc⁹,Köninger Jörg¹⁰,Schiff Jan-Henrik¹¹¹²,Wittel Uwe A.¹³,Hötzel Alexander¹⁴,Keck Tobias¹⁵,Nau Carla¹⁶,Amati Anca-Laura¹⁷,Koch Christian¹⁸,Diener Markus K.¹³,Weigand Markus A.⁵,Büchler Markus W.¹,Knebel Phillip¹,Larmann Jan⁵

Affiliation:

1. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany;

2. The Study Center of the German Surgical Society, Heidelberg University Hospital, Heidelberg, Germany;

3. Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany;

4. Translational Immunotherapy, German Cancer Research Center, Heidelberg, Germany

5. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

6. Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany

7. Department of General Surgery, University of Ulm, Ulm, Germany

8. Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany

9. General Medicine, Gemeinschaftspraxis für Allgemeinmedizin, Veitshöchheim, Germany

10. Department of General, Visceral, Thorax and Transplantation Surgery, Stuttgart, Germany

11. Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Stuttgart, Germany

12. Department of Anesthesiology and Intensive Care, Philipps-University Marburg, Marburg, Germany

13. Department of General and Visceral Surgery, Medical Centre, University of Freiburg, Freiburg, Germany

14. Department of Anesthesiology and Critical Care, Medical Centre, University of Freiburg, Freiburg, Germany

15. Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Germany

16. Department of Anesthesiology and Intensive Care, University Medical Centre Schleswig-Holstein, Campus Lübeck, Germany

17. Department of Visceral, Thoracic, Transplant and Pediatric Surgery, Justus Liebig University of Giessen, Giessen, Germany

18. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany.

Abstract

BACKGROUND: Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are common forms of analgesia after pancreatic surgery. Current guidelines recommend EDA over PCIA, and evidence suggests that EDA may improve long-term survival after surgery, especially in cancer patients. The aim of this study was to determine whether perioperative EDA is associated with an improved patient prognosis compared to PCIA in pancreatic surgery. METHODS: The PAKMAN trial was an adaptive, pragmatic, international, multicenter, randomized controlled superiority trial conducted from June 2015 to October 2017. Three to five years after index surgery a long-term follow-up was performed from October 2020 to April 2021. RESULTS: For long-term follow-up of survival, 109 patients with EDA were compared to 111 patients with PCIA after partial pancreatoduodenectomy (PD). Long-term follow-up of quality of life (QoL) and pain assessment was available for 40 patients with EDA and 45 patients with PCIA (questionnaire response rate: 94%). Survival analysis revealed that EDA, when compared to PCIA, was not associated with improved overall survival (OS, HR, 1.176, 95% HR-CI, 0.809–1.710, P = .397, n = 220). Likewise, recurrence-free survival did not differ between groups (HR, 1.116, 95% HR-CI, 0.817–1.664, P = .397, n = 220). OS subgroup analysis including only patients with malignancies showed no significant difference between EDA and PCIA (HR, 1.369, 95% HR-CI, 0.932–2.011, P = .109, n = 179). Similar long-term effects on QoL and pain severity were observed in both groups (EDA: n = 40, PCIA: n = 45). CONCLUSIONS: Results from this long-term follow-up of the PAKMAN randomized controlled trial do not support favoring EDA over PCIA in pancreatic surgery. Until further evidence is available, EDA and PCIA should be considered similar regarding long-term survival.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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