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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2022

12-08-2022 | Esophageal Cancer | Gastrointestinal Oncology

Short-Term Outcomes of Epidural Analgesia in Minimally Invasive Esophagectomy for Esophageal Cancer: Nationwide Inpatient Data Study in Japan

Authors: Yuki Hirano, MD, PhD, Hidehiro Kaneko, MD, PhD, Takaaki Konishi, MD, Hidetaka Itoh, MD, Satoru Matsuda, MD, PhD, Hirofumi Kawakubo, MD, PhD, Kazuaki Uda, MPH, PhD, Hiroki Matsui, MPH, Kiyohide Fushimi, MD, PhD, Hiroyuki Daiko, MD, PhD, Osamu Itano, MD, PhD, Hideo Yasunaga, MD, PhD, Yuko Kitagawa, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2022

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Abstract

Background

Studies have shown that epidural analgesia (EDA) is associated with a decreased risk of pneumonia and anastomotic leakage after esophagectomy, and several guidelines strongly recommend EDA use after esophagectomy. However, the benefit of EDA use in minimally invasive esophagectomy (MIE) remains unclear.

Objective

The aim of this retrospective study was to compare the short-term outcomes between patients with and without EDA undergoing MIE for esophageal cancer.

Methods

Data of patients who underwent oncologic MIE (April 2014–March 2019) were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the associations between EDA use and short-term outcomes, adjusting for potential confounders.

Results

Among 12,688 eligible patients, EDA was used in 9954 (78.5%) patients. In-hospital mortality, respiratory complications, and anastomotic leakage occurred in 230 (1.8%), 2139 (16.9%), and 1557 (12.3%) patients, respectively. In stabilized IPTW, EDA use was significantly associated with decreased in-hospital mortality (odds ratio [OR] 0.46 [95% confidence interval 0.34–0.61]), respiratory complications (OR 0.74 [0.66–0.84]), and anastomotic leakage (OR 0.77 [0.67–0.88]). EDA use was also associated with decreased prolonged mechanical ventilation, unplanned intubation, nonsteroidal anti-inflammatory drug use, acetaminophen use, postoperative length of stay, and total hospitalization costs and increased vasopressor use. One-to-three propensity score matching and instrumental variable analyses demonstrated equivalent results.

Conclusions

EDA use in oncologic MIE was associated with low in-hospital mortality as well as decreased respiratory complications, and anastomotic leakage, suggesting the potential advantage of EDA use in MIE.
Appendix
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Metadata
Title
Short-Term Outcomes of Epidural Analgesia in Minimally Invasive Esophagectomy for Esophageal Cancer: Nationwide Inpatient Data Study in Japan
Authors
Yuki Hirano, MD, PhD
Hidehiro Kaneko, MD, PhD
Takaaki Konishi, MD
Hidetaka Itoh, MD
Satoru Matsuda, MD, PhD
Hirofumi Kawakubo, MD, PhD
Kazuaki Uda, MPH, PhD
Hiroki Matsui, MPH
Kiyohide Fushimi, MD, PhD
Hiroyuki Daiko, MD, PhD
Osamu Itano, MD, PhD
Hideo Yasunaga, MD, PhD
Yuko Kitagawa, MD, PhD
Publication date
12-08-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12346-x

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