The impact of postoperative Patient-controlled epidural versus patient- controlled intravenous analgesia on cancer recurrence following minimally invasive esophagectomy: A retrospective analysis

Background: Surgical resection, for the most part after neoadjuvant therapy, remains the primary curative option for esophageal cancer, yet cancer recurrence poses a significant challenge to patient outcomes. Previous literature has shown that various anesthetic drugs could potentially influence oncological outcomes after surgical resection of malignant tumors. This retrospective cohort study investigates the influence of patient-controlled epidural analgesia (PCEA) compared to patient-controlled intravenous analgesia (PCIA) on cancer recurrence following minimally invasive and hybrid esophagectomy. Methods: A single center database analysis was conducted and 290 patients who underwent minimally invasive and hybrid esophagectomy between 2014 and 2020 were included in the analysis. Primary outcome was time to cancer recurrence. Time to death was considered a secondary outcome. A competing risk analysis was conducted using a cumulative incidence function. Results: No statistical significant difference in recurrence-free survival time was found between patients with patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCIA) following esophagectomy, hazard ratio (HR) 1.08 with a 95% confidence interval (CI) of [0.63, 1.86]. For time to death no statistical significant difference could be found between PCEA and PCIA group following esophagectomy, HR of 0.87 with a 95% CI of [0.46, 1.64]. Conclusion: No statistical significant oncological or survival benefit could be found in patients treated with PCEA after minimally invasive esophagectomy. Despite the absence of statistical significant findings on cancer recurrence in this study, the well-established benefits of epidural analgesia in postoperative pain management and opioid reduction remain pertinent. Further research, particularly randomized controlled trials, is necessary to elucidate the potential impact of anesthesiologic techniques on oncological outcomes in esophageal cancer surgery.