Tom 6, Nr 4 (2021)
Praca badawcza (oryginalna)
Opublikowany online: 2021-06-09

dostęp otwarty

Wyświetlenia strony 155
Wyświetlenia/pobrania artykułu 102
Pobierz cytowanie

Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Does epidural analgesia modify the risk of complications after gastrectomy?

Tomasz Olesiński1, Marta Urbańska1, Anna Borkowska2, Paulina Wieszczy13, Dariusz Król1, Dorota Rucz4, Małgorzata Symonides1
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2021;6(4):266-275.


Introduction. The surgical treatment of Gastric Cancer is associated with overall complication rates as high as 50%. The intent of this study was to assess the impact of epidural analgesia (EA) on postoperative complication rates among patients undergoing gastric resections.

Materials and methods. Of the 617 gastric cancer patients who between 2002 and 2010 had undergone stomach resection, 246 (39.8%) were administered EA. Groups with and without EA were compared.

Results. The general rate of complications was lower in the EA group in the univariable analysis – 38.5% vs. 54.2% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.34–0.66, p < 0.001), intra-abdominal abscess (OR 0,28, 95% CI: 0.14–0.59, p = 0.001), pneumonia (OR 0,39, 95% CI: 0.24–0.63, p < 0.001), temperature > 38°C (OR 0.53, 95% CI: 0.37–0.74, p < 0.001) and re-operation (OR 0.53, 95% CI: 0.28–1.00, p = 0.049). These relationships were confirmed in a multivariable analysis for the general number of complications (OR 0.53, 95% CI: 0.37–0.75, p < 0.001), intra-abdominal abscess (OR 0.36, 95% CI: 0.16–0.77, p = 0.009), temperature > 38°C (OR 0.56, 95% CI: 0.39–0.82, p = 0.009), pneumonia (OR 0.42, 95% CI: 0.25–0.71, p = 0.001).

Conclusions. Our findings indicate that postoperative treatment with EA for patients undergoing stomach resection is safe and contributes to a reduction in the number of postoperative complications.

Artykuł dostępny w formacie PDF

Pokaż PDF (angielski) Pobierz plik PDF


  1. Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2. Cancer Incidence and Mortality Worldwide: IARC Cancer Base No.10. Lyon, France: International Agency for Research on Cancer. 2010.
  2. European Union Network of Excellence (EUNE) for Gastric Cancer Steering Group. Gastric cancer in Europe. Br J Surg. 2008; 95(4): 406–408.
  3. Krajowy rejestr nowotworów.
  4. Angelis RDe, Sant M, Coleman M, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncol. 2014; 15(1): 23–34.
  5. Smyth EC, Verheij M, Allum W, et al. ESMO Guidelines Committee. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016; 27(suppl 5): v38–v49.
  6. Brar SS, Mahar AL, Helyer LK, et al. Processes of care in the multidisciplinary treatment of gastric cancer: results of a RAND/UCLA expert panel. JAMA Surg. 2014; 149(1): 18–25.
  7. Ajani JA, Bentrem DJ, Besh S, et al. National Comprehensive Cancer Network. Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2013; 11(5): 531–546.
  8. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14(2): 113–123.
  9. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004; 22(14): 2767–2773.
  10. Wu CW, Hsiung CA, Lo SS, et al. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004; 91(3): 283–287.
  11. Memon MA, Subramanya MS, Khan S, et al. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011; 253(5): 900–911.
  12. Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade. Hepatogastroenterology. 2004; 51(56): 613–617.
  13. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996; 347(9007): 995–999.
  14. Barchi LC, Charruf AZ, de Oliveira RJ, et al. Management of postoperative complications of lymphadenectomy. Transl Gastroenterol Hepatol. 2016; 1: 92.
  15. Yamada T, Hayashi T, Cho H, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012; 15(1): 34–41.
  16. Sugisawa N, Tokunaga M, Makuuchi R, et al. A phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery. Gastric Cancer. 2016; 19(3): 961–967.
  17. Niemi G, Breivik H. Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery. A randomised, double-blind, cross-over study with and without adrenaline. Acta Anaesthesiol Scand. 1998; 42(8): 897–909.
  18. Gil-Rendo A, Hernández-Lizoain JL, Martínez-Regueira F, et al. Risk factors related to operative morbidity in patients undergoing gastrectomy for gastric cancer. Clin Transl Oncol. 2006; 8(5): 354–361.
  19. Songun I, Putter H, Kranenbarg EMK, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010; 11(5): 439–449.
  20. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995; 82(6): 1474–1506.
  21. Harukuni I, Yamaguchi H, Sato S, et al. The comparison of epidural fentanyl, epidural lidocaine, and intravenous fentanyl in patients undergoing gastrectomy. Anesth Analg. 1995; 81(6): 1169–1174.
  22. Wu Y, Liu F, Tang H, et al. The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy. Anesth Analg. 2013; 117(2): 507–513.
  23. Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth. 2001; 87(1): 47–61.
  24. Holte K, Kehlet H, Kehlet H, et al. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001; 87(1): 62–72.
  25. Komatsu H, Matsumoto S, Mitsuhata H, et al. Comparison of patient-controlled epidural analgesia with and without background infusion after gastrectomy. Anesth Analg. 1998; 87(4): 907–910.
  26. Ballantyne JC, Carr DB, deFerranti S, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998; 86(3): 598–612.
  27. Yanagimoto Y, Takiguchi S, Miyazaki Y, et al. Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia. Surg Today. 2016; 46(2): 229–234.
  28. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg. 2001; 234(4): 560–9; discussion 569.
  29. Guay J, Nishimori M, Kopp SL, et al. Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Database Syst Rev. 2016; 7(6): CD001893–1602.
  30. Pesco J, Young K, Nealon K, et al. Use and Outcomes of Epidural Analgesia in Upper Gastrointestinal Tract Cancer Resections. J Surg Res. 2021; 257: 433–441.

Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory