Epidural Analgesia for Colorectal Cancer Surgery
Experimental and Clinical studiesav
Wiebke Falk
Akademisk avhandling
Avhandling för medicine doktorsexamen i medicinsk vetenskap med inriktning kirurgi,
som kommer att försvaras offentligt torsdag den 03 juni 2021 kl. 09.00, Hörsal C1, Campus USÖ, Örebro Universitet
Opponent: Professor Jonas Åkeson Lunds Universitet
Örebro universitet
Institutionen för medicinska vetenskaper 70182 Örebro
Abstract
Wiebke Falk (2021): Epidural Analgesia for Colorectal Cancer Surgery. Experimental and Clinical Studies. Örebro Studies in Medicine 237. Epidural analgesia (EA) with local anaesthetics and opioids is used for pain management after colorectal cancer (CRC) surgery. In recent years, a possible beneficial effect of EA on cancer recurrence and survival after surgery has been proposed. The aim of this thesis was to study the effects of EA on short- and long-term postoperative outcomes after CRC surgery with curative intent.
Study I, an in vitro study, investigated the effects of two different local anaesthetics, lidocaine and ropivacaine, on cell viability and cell prolifer-ation in colon cancer cell lines SW480 and SW620. Neither lidocaine nor ropivacaine reduced cell viability or proliferation at systemically, by epi-dural administration achievable concentrations.
In study II, the effect of EA on the systemic level of different cytokines as a marker of inflammation was studied. Except for a reduced level of the anti-inflammatory cytokine IL-10, no other significant effects of EA on the systemic cytokine levels at two time points postoperatively could be shown, when compared to patients receiving intravenous morphine.
Study III was an epidemiological study, examining the question if EA affects postoperative complications and mortality after surgery using data from the Swedish Colorectal Cancer Registry and the Swedish Periopera-tive Registry. No association between EA and a reduction in postoperaPeriopera-tive complications or mortality could be established.
Study IV, a randomised, controlled trial, the effects of EA on disease-free survival (DFS), postoperative complications and pain after surgery were compared to patient-controlled intravenous analgesia with mor-phine. Apart from superior pain relief during the first postoperative day, no significant effects of EA on the occurrence of postoperative complica-tions, length of hospital stay or DFS were found.
Keywords: colorectal cancer, epidural analgesia, local anaesthetics, colon
cancer cells, inflammation, postoperative complications, pain, recurrence, disease-free survival, mortality.
Wiebke Falk, School of Medical Sciences, Örebro University, SE-70182 Örebro, Sweden, wiebke.falk@regionorebrolan.se
