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@ARTICLE{Klotz:287682,
      author       = {R. Klotz and A. Ahmed$^*$ and A. Tremmel and C. Büsch and
                      S. Tenckhoff and C. Doerr-Harim and J. F. Lock and E.-M.
                      Brede and J. Köninger and J.-H. Schiff and U. A. Wittel and
                      A. Hötzel and T. Keck and C. Nau and A.-L. Amati and C.
                      Koch and M. K. Diener and M. A. Weigand and M. W. Büchler
                      and P. Knebel and J. Larmann},
      title        = {{T}horacic {E}pidural {A}nalgesia {I}s {N}ot {A}ssociated
                      {W}ith {I}mproved {S}urvival {A}fter {P}ancreatic {S}urgery:
                      {L}ong-{T}erm {F}ollow-{U}p of the {R}andomized {C}ontrolled
                      {PAKMAN} {T}rial.},
      journal      = {Anesthesia $\&$ analgesia},
      volume       = {140},
      number       = {4},
      issn         = {0003-2999},
      address      = {[Erscheinungsort nicht ermittelbar]},
      publisher    = {Ovid},
      reportid     = {DKFZ-2024-00310},
      pages        = {798-810},
      year         = {2025},
      note         = {140(4):p 798-810, April 2025.},
      abstract     = {Perioperative thoracic epidural analgesia (EDA) and
                      patient-controlled intravenous analgesia (PCIA) are common
                      forms of analgesia after pancreatic surgery. Current
                      guidelines recommend EDA over PCIA, and evidence suggests
                      that EDA may improve long-term survival after surgery,
                      especially in cancer patients. The aim of this study was to
                      determine whether perioperative EDA is associated with an
                      improved patient prognosis compared to PCIA in pancreatic
                      surgery.The PAKMAN trial was an adaptive, pragmatic,
                      international, multicenter, randomized controlled
                      superiority trial conducted from June 2015 to October 2017.
                      Three to five years after index surgery a long-term
                      follow-up was performed from October 2020 to April 2021.For
                      long-term follow-up of survival, 109 patients with EDA were
                      compared to 111 patients with PCIA after partial
                      pancreatoduodenectomy (PD). Long-term follow-up of quality
                      of life (QoL) and pain assessment was available for 40
                      patients with EDA and 45 patients with PCIA (questionnaire
                      response rate: $94\%).$ Survival analysis revealed that EDA,
                      when compared to PCIA, was not associated with improved
                      overall survival (OS, HR, 1.176, $95\%$ HR-CI, 0.809-1.710,
                      P = .397, n = 220). Likewise, recurrence-free survival did
                      not differ between groups (HR, 1.116, $95\%$ HR-CI,
                      0.817-1.664, P = .397, n = 220). OS subgroup analysis
                      including only patients with malignancies showed no
                      significant difference between EDA and PCIA (HR, 1.369,
                      $95\%$ HR-CI, 0.932-2.011, P = .109, n = 179). Similar
                      long-term effects on QoL and pain severity were observed in
                      both groups (EDA: n = 40, PCIA: n = 45).Results from this
                      long-term follow-up of the PAKMAN randomized controlled
                      trial do not support favoring EDA over PCIA in pancreatic
                      surgery. Until further evidence is available, EDA and PCIA
                      should be considered similar regarding long-term survival.},
      cin          = {D196},
      ddc          = {610},
      cid          = {I:(DE-He78)D196-20160331},
      pnm          = {314 - Immunologie und Krebs (POF4-314)},
      pid          = {G:(DE-HGF)POF4-314},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38335141},
      doi          = {10.1213/ANE.0000000000006812},
      url          = {https://inrepo02.dkfz.de/record/287682},
}