Epidural Anesthesia and Long-term Outcomes in Elderly Patients After Surgery
Condition: Elderly Patients; Solid Organ Cancer; Surgical Resection; Epidural Anesthesia; Long-term Outcome
Study type: Interventional

Summary: 
      Surgical resection is one of the most important treatments for solid organ cancer. Whereas
      cancer recurrence and/or metastasis are the major reasons of treatment failure. The outcomes
      after surgery are mainly dependent on the balance between the immune function of the body and
      the invasiveness of residual cancer. Preclinical and retrospective studies suggest that
      anaesthetic techniques and drugs may affect the long-term outcomes in patients undergoing
      cancer surgery. The investigators hypothesize that epidural anesthesia-analgesia may improve
      long-term survival in the elderly who undergo major surgery for cancer.
    

Detailed description: 
      Surgical resection is the main treatment for potentially curable solid organ cancer. However,
      long-term survival after cancer surgery is far from satisfactory. Quite a number of patients
      develop tumor metastasis and/or recurrence after surgery, which are associated with poor
      long-term outcomes. The development of tumor recurrence and/or metastasis after surgery is
      mostly dependent on the balance between the anti-tumor immune function of the body and the
      ability of implantation, proliferation and neovascularization of the residual cancer cells.

      Studies showed that anaesthetic techniques and drugs may influence the cellular immune
      function and long-term outcomes. For example, it was found that ketamine and thiopental, but
      not propofol, suppresses natural killer (NK) cell activity; all three drugs caused a
      significant reduction in NK cell number; isoflurane and halothane inhibit interferon
      stimulation of NK cell cytotoxicity; nitrous oxide interferes with deoxyribonucleic acid,
      purine, and thymidylate synthesis and depresses neutrophil chemotaxis; opioids have been
      shown to suppress cell-mediated and humoral immunity.

      Considering the potential harmful effects of general anesthesia/anesthetics, there is
      increasing interest on the effect of regional anaesthesia. Retrospective studies
      investigating the relationship between epidural anesthesia and outcomes after cancer surgery
      provide different results. In a meta-analysis of retrospective studies, regional anesthesia
      was associated with improved survival, but had no effect on the occurrence of cancer
      recurrence/metastasis. The investigators hypothesize that epidural anesthesia may produce
      favorable effects on long-term survival in the elderly who undergo major surgery for cancer
      under general anesthesia. However, there are no sufficient evidences in this aspect.
    

Intervention name(s): Combined epidural-general anesthesia; General anesthesia
Intervention type(s): Procedure; Procedure
Intervention description(s): Combined epidural-general anesthesia and postoperative epidural analgesia.; General anesthesia and postoperative intravenous analgesia.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Elderly; Cancer surgery; Epidural anesthesia and analgesia; Long-term survival