Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial

OBJECTIVE: To compare long term recurrence of cancer and survival of patients having major abdominal surgery for cancer. DESIGN: Long term follow-up of prospective randomised controlled clinical trial in which patients were randomly assigned to receive general anaesthesia with or without epidural block for at least three postoperative days. Setting 23 hospitals in Australia, New Zealand, and Asia. PARTICIPANTS: 503 adult patients who had potentially curative surgery for cancer. MAIN OUTCOME MEASURE: Cancer-free survival (analysis was by intention to treat). RESULTS: Long term follow-up data were available for 94% (n=446) of eligible participants. The median time to recurrence of cancer or death was 2.8 (95% confidence interval 0.7 to 8.7) years in the control group and 2.6 (0.7 to 8.7) years in the epidural group (P=0.61). Recurrence-free survival was similar in both epidural and control groups (hazard ratio 0.95, 95% confidence interval 0.76 to 1.17; P=0.61). CONCLUSION: Use of epidural block in abdominal surgery for cancer is not associated with improved cancer-free survival. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12607000637448.