Patients Undergoing Gastric Cancer Surgery with Epidural Combined with General Anesthesia and General Anesthesia

Background: Gastric cancer (GC) is one of the leading causes of mortality and morbidity and adds significantly financial burden to patient and their family on healthcare. The incidence of gastric cancer continues to increase in Bangladesh; therefore there is unmet need of promising treatment modalities. Objective: To investigate the survival of patients undergoing gastric cancer surgery with epidural combined with general anesthesia (EGA) and general anesthesia alone (GA). Methods: A retrospectively observation study was carried out at the Dept. of Anesthesia, National Institute of Cancer Research & Hospital (NICRH), Mohakhali, Dhaka, Bangladesh from June 2021 March 2022. 451 patients with gastric cancer who were scheduled for radical resection. Propensity score matching was performed at a 1:1 ratio between GA (n=75) and EGA (n=75) to reduce selection bias. Univariate and multivariate analyses were used to identify factors significantly correlated with recurrence and/or metastasis and prognosis. The 3-year overall survival rates of patients receiving EGA and GA alone were compared. Results: After the propensity scores were matched, there were 75 patients who underwent EGA and 75 patients who underwent GA. For the entire population, reconstruction type, pN stage, and complications were significantly correlated with prognosis based on multivariate analyses. For patients with a recurrence and/or metastasis, lymphadenectomy and pN stage were shown to be independent prognostic factors by multivariate analysis. Conclusions: In summary, patients might benefit from EGA as a result of better analgesic and anti-inflammatory effects, fewer postoperative complications, higher safety, and a lower rate of metastasis and recurrence is conducive to postoperative recovery in patients with gastric cancer.