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Cervical Epidural Anesthesia Is Associated With Increased Cancer-Free Survival in Laryngeal and Hypopharyngeal Cancer Surgery: A Retrospective Propensity-Matched Analysis
  1. Fanette Merquiol, MD*,
  2. Anne-Sophie Montelimard, MD*,
  3. Alice Nourissat, MD,
  4. Serge Molliex, MD, PhD* and
  5. Paul Jacques Zufferey, MD, PhD*
  1. *Department of Anesthesiology and Intensive Care, University Hospital of Saint-Etienne, Saint-Etienne cedex; and Public Health Department, Institut de Cancerologie de la Loire, Saint-Priest en Jarez, France.
  1. Address correspondence to: Fanette Merquiol, MD, Department of Anesthesiology and Intensive Care, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 02, France (e-mail: fanette.merquiol{at}


Background and Objectives Regional anesthesia preserves perioperative immune competence and may reduce the risk of recurrence and metastasis after cancer surgery. Cervical epidural anesthesia provides adequate analgesia for head and neck cancer surgery, but its impact on cancer recurrence is unknown.

Methods This study was a single-center retrospective cohort study of patients undergoing larynx or hypopharynx cancer surgery between January 1984 and December 2008. One hundred eleven patients had general anesthesia combined with intraoperative and postoperative cervical epidural; 160 had general anesthesia alone with postoperative morphine. From this cohort, matched pairs were selected using a propensity score to balance potential confounders of receiving epidural anesthesia. The primary end point was the length of cancer-free survival after surgery until September 2009.

Results Propensity-based matching produced 65 pairs. Matching was effective in achieving balance between groups for each of the preoperative variables collected. Combined epidural and general anesthesia (68% 5-year cancer-free survival; 95% confidence interval [CI], 57%–82%) was associated with significantly increased cancer-free survival compared with general anesthesia alone (37% 5-year cancer-free survival; 95% CI, 25%–54%) with a corresponding adjusted hazard ratio of 0.49 (95% CI, 0.25–0.96; P = 0.04). Patients in the epidural group had an increased overall survival compared with the non–epidural group (P = 0.03).

Conclusions The association between cervical epidural anesthesia and increased cancer-free survival found in this retrospective study should be an important hypothesis to further investigate in head and neck cancer surgery.

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  • The authors declare no conflict of interest.

    None of the authors received funding for this study.

    Preliminary results of this work were presented at the American Society of Anesthesiologists Annual Meeting, October 16–20, 2010, San Diego, CA.

    Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

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