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| Systematic evaluation and meta-analysis of pain and prognosis after radical gastrectomy under general anesthesia combined with epidural anesthesia and general anesthesia alone |
| ZHI Xiaoyan1 XUE Xiaoyun1 TIAN Yi1 YANG Liqiang2 MA Jun3 LU Guijun4 LI Yan2▲ |
1.Department of Anesthesiology and Pain Medicine, Central South University Xiangya School of Medical Affiliated Haikou Hospital (Haikou People′s Hospital), Hainan Province, Haikou 570208, China;
2.Department of Pain Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
3.Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
4.Department of Pain Medicine, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing 102218, China |
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Abstract Objective To systematically evaluate the effects of general anesthesia combined with epidural anesthesia and general anesthesia alone on postoperative pain and prognosis of radical gastrectomy, and to conduct meta-analysis. Methods The Cochrane library, PubMed database, MEDLINE database, EMBASE database, Chinese biomedical literature database and CNKI database were searched by computer from the establishment of the database to January 2018. Chinese search words: general anesthesia, epidural anesthesia, gastric cancer, gastric malignancy, gastrectomy, case-control study, cohort study, randomized controlled trial. English search words: epidural anesthesia, general anesthesia, gastric cancer. Literature screening and data extraction were conducted independently by 2 staff members. The results of screening and data extraction shall be checked by the third staff member. If there was any discrepancy, it shall be discussed and agreed upon. Main outcome measures: survival rate, incidence of pulmonary infection and length of hospital stays. Results Eight studies were included, including a total of 5105 patients receiving radical gastrectomy for gastric cancer. 1817 patients receiving general anesthesia combined with epidural anesthesia and 3288 patients receiving general anesthesia alone. Meta-analysis showed that, there was no significant difference in survival rate between the two anesthesia methods (HR = 0.78, 95%CI:0.60, 1.01, P ＞ 0.05). The incidence of pulmonary infection under general anesthesia combined with epidural anesthesia was lower than that under general anesthesia alone(RR = 0.28, 95%CI:0.15, 0.52), and the length of hospital stays were shorter than that under general anesthesia alone (MD = -1.50, 95%CI:-2.62, -0.39), with statistically significant differences (all P < 0.05). Conclusion General anesthesia combined with epidural anesthesia may improve the survival rate of patients after radical gastrectomy and pulmonary infection rate, and shorten hospital stays. The above conclusions may have confounding bias and detection bias, which should be used with caution in clinical practice. More specific conclusions need to be confirmed by a large randomized controlled trial.
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[1] Chen W，Zheng R，Baade PD，et al. Cancer statistics in China，2015 [J]. CA Cancer J Clin，2016，66（2）：115-132.
[2] Meng W，Bai B，Sheng L，et al. Role of Helicobacter Pylori in Gastric Cancer：Advances and Controversies [J]. Discov Med，2015，20（111）：285-293.
[3] Henriksen MG，Jensen MB，Hansen HV，et al. Enforced mobilization，early oral feeding，and balanced analgesia improve convalescence after colorectal surgery [J]. Nutrition，2002，18（2）：147-152.
[4] Zhou J，Zhou Y，Cao S，et al. Multivariate logistic regression analysis of postoperative complications and risk model establishment of gastrectomy for gastric cancer：A single-center cohort report [J]. Scand J Gastroenterol，2016， 51（1）：8-15.
[5] Cakmakkaya OS，Kolodzie K，Apfel CC，et al. Anaesthetic techniques for risk of malignant tumour recurrence [J]. Cochrane Database Syst Rev，2014，7（11）：CD 008 877.
[6] Higgins JPT，Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [EB/OL]. http://www.cochrane-handbook.org. [2011-03]
[7] Moher D，Liberati A，Tetzlaff J，et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement [J]. BMJ. 2009，151（4）：264-269.
[8] 钟惠，江英强，尹亚岚，等.麻醉方式对胃癌患者术后呼吸道感染及T淋巴细胞和应激水平的影响[J].中华医院感染学杂志，2017，27（3）：609-612.
[9] 王泽华，胡文庆，郭焱，等.全身麻醉复合硬膜外麻醉对胃癌根治术患者肺功能及术后肺部感染的影响[J].中华医院感染学杂志，2017，27（6）：1301-1304.
[10] Wang Y，Liu X，Li H. Incidence of the post-operative cognitive dysfunction in elderly patients with general anesthesia combined with epidural anesthesia and patient-controlled epidural analgesia [J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban，2016，41（8）：846-851.
[11] Liu F，Zhang J，Zeng XQ，et al. Application of general anesthesia combined with epidural anesthesia/analgesia in rehabilitation after gastric cancer resection [J]. Zhonghua yi xue za zhi，2017，97（14）：1089-1092.
[12] Zhao J，Mo H. The Impact of Different Anesthesia Methods on Stress Reaction and Immune Function of the Patients with Gastric Cancer during Peri-Operative Period [J]. J Med Assoc Thai，2015，98（6）：568-573.
[13] Yanagimoto Y，Takiguchi S，Miyazaki Y，et al. Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia [J]. Surg Today，2016，46（2）：229-234.
[14] Wang Y，Wang L，Chen H，et al. The effects of intra- and post-operative anaesthesia and analgesia choice on outcome after gastric cancer resection：a retrospective study [J]. Oncotarget，2017，8（37）：62 658-62 665.
[15] Wang J，Guo W，Wu Q，et al. Impact of Combination Epidural and General Anesthesia on the Long-Term Survival of Gastric Cancer Patients：A Retrospective Study [J]. Med Sci Monit，2016，22：2379-2385.
[16] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation [J]. Br J Anaesth，1997， 78（5）：606-617.
[17] Fearon KC，Ljungqvist O，Von MM，et al. Enhanced recovery after surgery：a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr，2005， 24（3）：466-477.
[18] Kehlet H，Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg，2002，183（6）：630-641.
[19] Nimmo SM，Foo ITH，Paterson HM. Enhanced recovery after surgery：Pain management [J]. J Surg Oncol，2017， 116（5）：583-591.
[20] Zhu Z，Wang C，Xu C，et al. Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer：a prospective randomized trial [J]. Gastric Cancer，2013，16（2）：193-200.
[21] Kun L，Tang L，Wang J，et al. Effect of Combined General/Epidural Anesthesia on Postoperative NK Cell Activity and Cytokine Response in Gastric Cancer Patients Undergoing Radical Resection [J]. Hepatogastroenterology，2014，61（132）：1142-1147.
[22] Stubbs BM，Badcock KJ，Hyams C，et al. A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the Enhanced Recovery After Surgery programme [J]. Colorectal Dis，2013，15（6）：733-736.
[23] Kim BS，Yook JH，Choi YB，et al. Comparison of Early Outcomes of Intracorporeal and Extracorporeal Gastroduodenostomy After Laparoscopic Distal Gastrectomy for Gastric Cancer [J]. J Laparoendosc Adv Surg Tech A，2011， 21（5）：387-391. |
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