Paravertebral Block Does Not Reduce Cancer Recurrence, but Is Related to Higher Overall Survival in Lung Cancer Surgery: A Retrospective Cohort Study
- Authors
- Lee, Eun Kyung; Ahn, Hyun Joo; Zo, Jae Iii; Kim, Kyunga; Jung, Dae Myung; Park, Joo Hyun
- Issue Date
- Oct-2017
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Citation
- ANESTHESIA AND ANALGESIA, v.125, no.4, pp 1322 - 1328
- Pages
- 7
- Journal Title
- ANESTHESIA AND ANALGESIA
- Volume
- 125
- Number
- 4
- Start Page
- 1322
- End Page
- 1328
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/71744
- DOI
- 10.1213/ANE.0000000000002342
- ISSN
- 0003-2999
1526-7598
- Abstract
- BACKGROUND: Postoperative analgesic methods are suggested to have an impact on long-term prognosis after cancer surgery through opioid-induced immune suppression. We hypothesized that regional analgesia that reduces the systemic opioid requirement would be related to lower cancer recurrence and higher overall survival compared to intravenous patient-controlled analgesia (PCA) for lung cancer surgery. METHODS: Records for all patients who underwent open thoracotomy for curative resection of primary lung cancer between 2009 and 2013 in a tertiary care hospital were retrospectively analyzed. Patients were divided by postoperative analgesic methods: PCA (n = 574), thoracic epidural analgesia (TEA, n = 619), or paravertebral block (PVB, n = 536). Overall and recurrence free survivals were compared among 3 analgesic methods via a multivariable Cox proportional hazard model and a log-rank test after adjusting confounding factors using propensity score matching (PSM). RESULTS: Analgesic method was associated with overall survival (P = .0015; hazard ratio against TEA [95% confidence intervals]: 0.58 [0.39-0.87] for PCA, 0.60 [0.45-0.79] for PVB). After confounder adjustment using PSM, PVB showed higher overall survival than PCA (log-rank P = .0229) and TEA (log-rank P = .0063) while PCA and TEA showed no difference (log-rank P = .6). Hazard ratio for PVB was 0.66 [0.46-0.94] against PCA and 0.65 [0.48-0.89] against TEA after PSM. However, there was no significant association between the analgesic methods and recurrence-free survival (P = .5; log-rank P with PSM = .5 between PCA and TEA,.5 between PCA and PVB, .1 between TEA and PVB). CONCLUSIONS: Pain-control methods are not related to cancer recurrence. However, PVB may have a beneficial effect on overall survival of patients with lung cancer.
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